- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,786.30 / $11,748.98
| Professional | | $4,365.16 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,715.19 / $30,199.52
| Facility | | $5,754.40 | $10,715.19 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $8,128.31 / $9,549.93
| Professional | | $512.86 | $8,128.31 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,495.41 / $9,120.11
| Facility | | $2,884.03 | $5,495.41 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $4,786.30 / $7,762.47
| Professional | | $645.65 | $4,786.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $25,118.86 / $37,153.52
| Facility | | $19,952.62 | $25,118.86 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $13,489.63 / $16,982.44
| Professional | | $10,964.78 | $13,489.63 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $29,512.09
| Professional | | $9,549.93 | $9,549.93 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $25,118.86 / $66,069.34
| Facility | | $12,022.64 | $25,118.86 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $933.25 / $1,905.46
| Professional | | $398.11 | $933.25 | $1,905.46 |