- 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
- $532.62 / $532.62 / $532.62
| Professional | | $532.62 | $532.62 | $532.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,547.24 / $21,070.51 / $39,554.72
| Facility | | $15,547.24 | $21,070.51 | $39,554.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.00 / $1,033.84 / $1,059.71
| Professional | | $977.00 | $1,033.84 | $1,059.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.31 / $1,323.34 / $2,486.65
| Professional | | $789.31 | $1,323.34 | $2,486.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.62 / $932.09 / $29,914.78
| Facility | | $532.62 | $932.09 | $29,914.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.92 / $1,347.53 / $4,300.24
| Professional | | $737.92 | $1,347.53 | $4,300.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.31 / $1,323.34 / $22,147.63
| Facility | | $789.31 | $1,323.34 | $22,147.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.31 / $1,005.11 / $2,486.65
| Professional | | $789.31 | $1,005.11 | $2,486.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.45 / $1,335.75 / $1,637.36
| Professional | | $851.45 | $1,335.75 | $1,637.36 |