- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $9,549.93 / $70,794.58
| Facility | | $3,162.28 | $9,549.93 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,290.87 / $9,549.93
| Professional | | $1,548.82 | $2,290.87 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $4,265.80
| Professional | | $1,698.24 | $2,511.89 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $5,011.87
| Professional | | $32.36 | $33.11 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $30,199.52 / $67,608.30
| Facility | | $25,703.96 | $30,199.52 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,630.78 / $7,413.10
| Professional | | $2,818.38 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $5,623.41
| Professional | | $1,698.24 | $3,890.45 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,019.95 / $4,466.84
| Professional | | $2,290.87 | $3,019.95 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,128.61 / $24,547.09
| Facility | | $3,311.31 | $5,128.61 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,949.84 / $2,951.21
| Professional | | $1,584.89 | $1,949.84 | $2,951.21 |