- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,951.21 / $6,456.54
| Facility | | $1,148.15 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $741.31 / $1,230.27
| Professional | | $269.15 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $14,791.08
| Facility | | $2,454.71 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $933.25 / $1,949.84
| Professional | | $371.54 | $933.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $954.99 / $2,089.30
| Professional | | $389.05 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $50,118.72
| Facility | | $24,547.09 | $24,547.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,471.29
| Professional | | $10,232.93 | $10,232.93 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,317.64 / $15,135.61
| Facility | | $4,365.16 | $8,317.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $870.96 / $1,949.84
| Professional | | $316.23 | $870.96 | $1,949.84 |