- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,511.38 / $77,624.71
| Facility | | $2,454.71 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $6,760.83
| Professional | | $1,174.90 | $1,698.24 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $33,884.42 / $66,069.34
| Facility | | $25,703.96 | $33,884.42 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,905.46 / $2,570.40
| Professional | | $1,122.02 | $1,905.46 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $3,981.07
| Professional | | $1,737.80 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,691.53 / $24,547.09
| Facility | | $1,513.56 | $2,691.53 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,818.38 / $4,265.80
| Professional | | $1,621.81 | $2,818.38 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,548.13 / $4,168.69
| Professional | | $2,884.03 | $3,548.13 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Professional | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,691.53 / $3,548.13
| Professional | | $1,862.09 | $2,691.53 | $3,548.13 |