- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,413.10 / $44,668.36
| Facility | | $3,162.28 | $7,413.10 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $8,317.64
| Professional | | $1,380.38 | $1,949.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $3,235.94
| Professional | | $1,445.44 | $2,137.96 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,174.90
| Professional | | $32.36 | $33.11 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $23,988.33 / $54,954.09
| Facility | | $20,417.38 | $23,988.33 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $3,801.89
| Professional | | $1,995.26 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,818.38 / $3,715.35
| Professional | | $1,348.96 | $2,818.38 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,290.87 / $3,388.44
| Professional | | $1,905.46 | $2,290.87 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,128.61 / $24,547.09
| Facility | | $3,311.31 | $5,128.61 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $2,570.40
| Professional | | $1,318.26 | $1,698.24 | $2,570.40 |