- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,309.57 / $33,884.42
| Facility | | $1,380.38 | $6,309.57 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,041.74 / $3,235.94
| Professional | | $1,621.81 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $12,589.25 / $53,703.18
| Facility | | $398.11 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,570.40 / $4,073.80
| Professional | | $1,659.59 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $20,892.96 / $33,113.11
| Facility | | $9,120.11 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $2,344.23
| Professional | | $954.99 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,884.03
| Professional | | $32.36 | $33.11 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $15,135.61 / $27,542.29
| Facility | | $6,165.95 | $15,135.61 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,041.74 / $3,715.35
| Professional | | $1,445.44 | $2,041.74 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $2,344.23
| Professional | | $1,318.26 | $1,318.26 | $2,344.23 |