- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,943.28 / $14,454.40
| Facility | | $3,548.13 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,698.24 / $3,548.13
| Professional | | $380.19 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,715.19 / $20,892.96
| Facility | | $8,128.31 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,412.54 / $3,388.44
| Professional | | $407.38 | $1,412.54 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,122.02 / $5,128.61
| Professional | | $478.63 | $1,122.02 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,884.03 / $9,549.93
| Facility | | $501.19 | $2,884.03 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $6,606.93
| Professional | | $2,344.23 | $3,630.78 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $3,715.35 / $5,370.32
| Professional | | $870.96 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $3,801.89
| Professional | | $776.25 | $776.25 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,585.78 / $9,772.37
| Facility | | $6,918.31 | $7,585.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $2,344.23 / $4,466.84
| Professional | | $524.81 | $2,344.23 | $4,466.84 |