- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.06 / $5,405.80 / $25,223.21
| Facility | | $443.06 | $5,405.80 | $25,223.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.06 / $4,437.97 / $7,218.83
| Professional | | $443.06 | $4,437.97 | $7,218.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,236.52 / $24,536.18 / $48,429.15
| Facility | | $14,236.52 | $24,536.18 | $48,429.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.76 / $2,958.34 / $15,151.87
| Professional | | $746.76 | $2,958.34 | $15,151.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,608.84 / $16,471.25 / $39,623.83
| Facility | | $11,608.84 | $16,471.25 | $39,623.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.51 / $2,755.84 / $18,975.52
| Professional | | $917.51 | $2,755.84 | $18,975.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,145.53 / $15,058.68 / $31,199.88
| Facility | | $9,145.53 | $15,058.68 | $31,199.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.27 / $6,140.80 / $15,370.46
| Professional | | $848.27 | $6,140.80 | $15,370.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.73 / $8,536.44 / $27,343.83
| Facility | | $697.73 | $8,536.44 | $27,343.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,311.33 / $12,203.16 / $21,402.82
| Professional | | $6,311.33 | $12,203.16 | $21,402.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $55,151.00
| Facility | | $5,028.00 | $11,496.00 | $55,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,565.34 / $9,921.48 / $20,436.23
| Professional | | $5,565.34 | $9,921.48 | $20,436.23 |