- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,025.60 / $10,964.78
| Facility | | $3,162.28 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,090.30 / $13,182.57
| Professional | | $2,238.72 | $3,090.30 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,715.35 / $5,754.40
| Professional | | $2,290.87 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $5,128.61
| Professional | | $32.36 | $33.11 | $5,128.61 |
- 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
- $3,801.89 / $4,897.79 / $10,964.78
| Professional | | $3,801.89 | $4,897.79 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $7,762.47
| Professional | | $2,137.96 | $5,623.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,073.80 / $6,025.60
| Professional | | $3,019.95 | $4,073.80 | $6,025.60 |
- 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
- $2,187.76 / $2,691.53 / $4,168.69
| Professional | | $2,187.76 | $2,691.53 | $4,168.69 |