- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $13,182.57
| Facility | | $5,128.61 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,466.84 / $6,456.54
| Professional | | $3,311.31 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $6,918.31
| Professional | | $1,698.24 | $2,089.30 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $41,686.94 / $114,815.36
| Facility | | $5,128.61 | $41,686.94 | $114,815.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $85,113.80 / $151,356.12
| Professional | | $6,760.83 | $85,113.80 | $151,356.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $11,481.54
| Facility | | $3,548.13 | $3,548.13 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,918.31
| Professional | | $6,309.57 | $6,309.57 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,918.31 / $31,622.78
| Facility | | $3,548.13 | $6,918.31 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,754.40 / $10,964.78
| Professional | | $4,073.80 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,897.79 / $5,495.41
| Facility | | $1,949.84 | $4,897.79 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $6,309.57
| Professional | | $2,290.87 | $3,311.31 | $6,309.57 |