- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $17,378.01
| Facility | | $1,621.81 | $4,897.79 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,398.83
| Professional | | $1,174.90 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $47,863.01 / $97,723.72
| Facility | | $22,908.68 | $47,863.01 | $97,723.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,862.09
| Professional | | $891.25 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $27,542.29 / $40,738.03
| Facility | | $1,819.70 | $27,542.29 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $3,019.95
| Facility | | $446.68 | $549.54 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $8,511.38
| Professional | | $1,584.89 | $1,584.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $19,498.45 / $26,302.68
| Facility | | $9,120.11 | $19,498.45 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,089.30 / $3,630.78
| Professional | | $1,659.59 | $2,089.30 | $3,630.78 |