- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $11,220.18
| Facility | | $1,380.38 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,715.35 / $5,370.32
| Professional | | $1,380.38 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $40,738.03 / $57,543.99
| Facility | | $16,982.44 | $40,738.03 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $933.25
| Professional | | $407.38 | $602.56 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $58,884.37 / $95,499.26
| Facility | | $3,981.07 | $58,884.37 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,230.27
| Facility | | $1,202.26 | $1,202.26 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $14,125.38 / $16,982.44
| Professional | | $794.33 | $14,125.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $13,803.84 / $20,417.38
| Facility | | $6,456.54 | $13,803.84 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $2,398.83
| Professional | | $812.83 | $1,202.26 | $2,398.83 |