- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,495.41 / $8,511.38
| Facility | | $1,621.81 | $5,495.41 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,089.30 / $5,128.61
| Professional | | $478.63 | $2,089.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,589.25 / $30,199.52
| Facility | | $5,370.32 | $12,589.25 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $3,388.44 / $4,265.80
| Professional | | $794.33 | $3,388.44 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $4,677.35
| Professional | | $616.60 | $891.25 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,754.23 / $8,511.38
| Facility | | $562.34 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $2,187.76 / $4,365.16
| Professional | | $630.96 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $25,118.86 / $37,153.52
| Facility | | $19,952.62 | $25,118.86 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $912.01 / $4,897.79
| Professional | | $831.76 | $912.01 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $26,302.68
| Professional | | $831.76 | $2,041.74 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $17,782.79 / $19,054.61
| Facility | | $12,022.64 | $17,782.79 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,995.26 / $4,073.80
| Professional | | $489.78 | $1,995.26 | $4,073.80 |