- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,943.28 / $14,454.40
| Facility | | $5,754.40 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,238.72 / $5,011.87
| Professional | | $1,949.84 | $2,238.72 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $41,686.94 / $81,283.05
| Facility | | $31,622.78 | $41,686.94 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $933.25 / $3,801.89
| Professional | | $416.87 | $933.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,235.94 / $5,248.07
| Professional | | $2,511.89 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $9,772.37 / $28,183.83
| Facility | | $2,691.53 | $9,772.37 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $4,786.30
| Professional | | $1,621.81 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,019.95 / $5,248.07
| Professional | | $2,511.89 | $3,019.95 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Professional | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,772.37 / $16,218.10
| Facility | | $1,862.09 | $9,772.37 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,818.38 / $4,570.88
| Professional | | $1,621.81 | $2,818.38 | $4,570.88 |