- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,888.44 / $8,511.38
| Facility | | $1,318.26 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,230.27 / $5,011.87
| Professional | | $776.25 | $1,230.27 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $1,995.26
| Professional | | $870.96 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,621.81
| Professional | | $32.36 | $33.11 | $1,621.81 |
- 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
- $1,174.90 / $1,778.28 / $2,290.87
| Professional | | $1,174.90 | $1,778.28 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,698.24 / $2,187.76
| Professional | | $831.76 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $2,137.96
| Professional | | $1,148.15 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $1,548.82
| Professional | | $794.33 | $977.24 | $1,548.82 |