- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,265.80 / $23,442.29
| Facility | | $1,778.28 | $4,265.80 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $7,585.78
| Professional | | $1,000.00 | $2,187.76 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $12,882.50 / $16,595.87
| Facility | | $10,232.93 | $12,882.50 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,548.82 / $2,454.71
| Professional | | $407.38 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,466.84 / $28,183.83
| Facility | | $1,445.44 | $4,466.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,137.96 / $27,542.29
| Professional | | $1,202.26 | $2,137.96 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $15,135.61
| Facility | | $3,162.28 | $4,786.30 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $5,011.87
| Professional | | $1,202.26 | $1,905.46 | $5,011.87 |