- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,244.36 / $17,378.01
| Facility | | $4,466.84 | $7,244.36 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,128.61 / $12,882.50
| Professional | | $4,168.69 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,709.64 / $11,220.18
| Professional | | $4,570.88 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,760.83 / $11,481.54
| Professional | | $3,981.07 | $6,760.83 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,623.41 / $8,912.51
| Facility | | $4,466.84 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $8,709.64 / $11,481.54
| Professional | | $15.14 | $8,709.64 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,370.32 / $10,232.93
| Professional | | $3,981.07 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $83,176.38 / $83,176.38
| Facility | | $56.23 | $83,176.38 | $83,176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,359.37 / $32,359.37 / $41,686.94
| Professional | | $32,359.37 | $32,359.37 | $41,686.94 |