- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $14,454.40
| Facility | | $5,128.61 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,818.38 / $5,495.41
| Professional | | $2,511.89 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,589.25 / $24,547.09
| Facility | | $9,549.93 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,073.80 / $5,495.41
| Professional | | $2,398.83 | $4,073.80 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $5,011.87 / $8,912.51
| Professional | | $676.08 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,890.45 / $6,165.95
| Facility | | $2,511.89 | $3,890.45 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,623.41 / $20,417.38
| Professional | | $3,162.28 | $5,623.41 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,309.57 / $8,912.51
| Professional | | $5,248.07 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,888.44 / $8,912.51
| Professional | | $4,677.35 | $5,888.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $3,890.45 / $7,079.46
| Professional | | $7.08 | $3,890.45 | $7,079.46 |
- 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
- $3,019.95 / $4,265.80 / $7,413.10
| Professional | | $3,019.95 | $4,265.80 | $7,413.10 |