- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,570.88 / $10,232.93
| Facility | | $1,819.70 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,288.25 / $5,128.61
| Professional | | $380.19 | $1,288.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,318.26 / $2,187.76
| Professional | | $446.68 | $1,318.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $870.96 / $5,370.32
| Professional | | $32.36 | $870.96 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,623.41 / $12,589.25
| Facility | | $4,786.30 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $5,128.61
| Professional | | $549.54 | $1,778.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,230.27 / $3,890.45
| Professional | | $436.52 | $1,230.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,698.24 / $2,691.53
| Professional | | $524.81 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $11,481.54
| Facility | | $2,137.96 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,047.13 / $1,905.46
| Professional | | $380.19 | $1,047.13 | $1,905.46 |