- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,548.13 / $10,715.19
| Facility | | $1,380.38 | $3,548.13 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,659.59 / $3,801.89
| Professional | | $436.52 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $13,489.63
| Facility | | $2,454.71 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,513.56 / $4,897.79
| Professional | | $524.81 | $1,513.56 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,380.38 / $4,073.80
| Professional | | $537.03 | $1,380.38 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $37,153.52 / $37,153.52
| Facility | | $54.95 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $18,197.01 / $18,197.01
| Professional | | $15,488.17 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,964.78 / $19,952.62
| Facility | | $6,456.54 | $10,964.78 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $2,041.74 / $4,677.35
| Professional | | $467.74 | $2,041.74 | $4,677.35 |