- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.81 / $11,611.47 / $24,068.03
| Facility | | $5,058.81 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.48 / $2,673.21 / $9,501.58
| Professional | | $458.48 | $2,673.21 | $9,501.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,172.22 / $19,955.61 / $38,600.60
| Facility | | $15,172.22 | $19,955.61 | $38,600.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.82 / $1,092.80 / $9,946.04
| Professional | | $480.82 | $1,092.80 | $9,946.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.15 / $9,797.98 / $17,166.45
| Professional | | $1,085.15 | $9,797.98 | $17,166.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.55 / $6,449.98 / $22,353.01
| Facility | | $584.55 | $6,449.98 | $22,353.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,750.83 / $13,066.91 / $19,614.07
| Professional | | $7,750.83 | $13,066.91 | $19,614.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.27 / $12,328.25 / $23,536.49
| Facility | | $1,196.27 | $12,328.25 | $23,536.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.15 / $10,110.68 / $16,797.91
| Professional | | $1,085.15 | $10,110.68 | $16,797.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,221.00 / $14,143.00 / $40,166.00
| Facility | | $11,221.00 | $14,143.00 | $40,166.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,943.27 / $11,626.25 / $14,768.32
| Professional | | $8,943.27 | $11,626.25 | $14,768.32 |