- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,495.41 / $10,715.19
| Facility | | $1,445.44 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $3,162.28
| Professional | | $1,412.54 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $2,754.23
| Facility | | $34.67 | $398.11 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,041.74 / $3,467.37
| Professional | | $1,288.25 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $20,892.96 / $33,113.11
| Facility | | $9,332.54 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $1,737.80
| Professional | | $977.24 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,290.87
| Professional | | $32.36 | $33.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $3,090.30
| Professional | | $1,202.26 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,548.82
| Professional | | $1,230.27 | $1,230.27 | $1,548.82 |