- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $26,302.68
| Facility | | $5,011.87 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,398.83 / $10,964.78
| Facility | | $977.24 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $14,454.40
| Professional | | $977.24 | $977.24 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $16,982.44 / $50,118.72
| Facility | | $5,754.40 | $16,982.44 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $14,125.38 / $14,454.40
| Professional | | $13,182.57 | $14,125.38 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,772.37 / $16,218.10
| Professional | | $6,025.60 | $9,772.37 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $16,982.44 / $75,857.76
| Facility | | $602.56 | $16,982.44 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $13,803.84 / $15,135.61
| Professional | | $10,964.78 | $13,803.84 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $7,079.46 / $19,054.61
| Professional | | $741.31 | $7,079.46 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $1,862.09
| Facility | | $537.03 | $851.14 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $7,943.28 / $14,791.08
| Professional | | $1,380.38 | $7,943.28 | $14,791.08 |