- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,943.28 / $14,454.40
| Facility | | $3,090.30 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $8,511.38
| Professional | | $1,445.44 | $1,905.46 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $27,542.29 / $53,703.18
| Facility | | $20,892.96 | $27,542.29 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,344.23 / $3,162.28
| Professional | | $1,380.38 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,548.13 / $4,897.79
| Professional | | $2,089.30 | $3,548.13 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,162.28 / $39,810.72
| Facility | | $1,862.09 | $3,162.28 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,311.31 / $18,620.87
| Professional | | $1,995.26 | $3,311.31 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,715.35 / $5,128.61
| Professional | | $3,548.13 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,090.30 / $4,265.80
| Professional | | $2,238.72 | $3,090.30 | $4,265.80 |