- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,606.93 / $11,481.54
| Facility | | $2,398.83 | $6,606.93 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $7,585.78
| Professional | | $1,348.96 | $2,290.87 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,762.47 / $30,199.52
| Facility | | $2,137.96 | $7,762.47 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $1,202.26
| Professional | | $549.54 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $41,686.94 / $89,125.09
| Facility | | $3,981.07 | $41,686.94 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $67,608.30 / $117,489.76
| Professional | | $5,248.07 | $67,608.30 | $117,489.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $60.26
| Professional | | $32.36 | $50.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $75.86
| Professional | | $60.26 | $60.26 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,220.18 / $16,218.10
| Facility | | $5,370.32 | $11,220.18 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $5,128.61
| Professional | | $1,023.29 | $1,548.82 | $5,128.61 |