- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $4,897.79
| Facility | | $1,380.38 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $208.93 / $302.00
| Professional | | $173.78 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $19,952.62 / $27,542.29
| Facility | | $8,709.64 | $19,952.62 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $691.83
| Professional | | $251.19 | $295.12 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,897.79 / $43,651.58
| Facility | | $309.03 | $4,897.79 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,981.07
| Facility | | $3,388.44 | $3,388.44 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,549.93 / $16,218.10
| Facility | | $3,890.45 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $602.56
| Professional | | $234.42 | $354.81 | $602.56 |