- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,611.47 / $24,068.03
| Facility | | $5,463.36 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.62 / $951.62 / $5,578.70
| Professional | | $951.62 | $951.62 | $5,578.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,547.24 / $20,448.87 / $39,554.72
| Facility | | $15,547.24 | $20,448.87 | $39,554.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.22 / $1,552.47 / $2,091.40
| Professional | | $920.22 | $1,552.47 | $2,091.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,917.65 / $2,305.61 / $2,583.10
| Professional | | $1,917.65 | $2,305.61 | $2,583.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.32 / $1,810.62 / $14,117.05
| Facility | | $1,213.32 | $1,810.62 | $14,117.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.52 / $2,156.21 / $8,672.74
| Professional | | $1,297.52 | $2,156.21 | $8,672.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.65 / $2,305.61 / $2,724.08
| Facility | | $1,917.65 | $2,305.61 | $2,724.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,575.39 / $2,134.37 / $2,724.08
| Professional | | $1,575.39 | $2,134.37 | $2,724.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.52 / $2,186.96 / $2,497.05
| Professional | | $1,297.52 | $2,186.96 | $2,497.05 |