- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $8,511.38
| Facility | | $2,454.71 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,348.96 / $2,454.71
| Professional | | $338.84 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,778.28 / $2,454.71
| Professional | | $467.74 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $8,317.64
| Professional | | $32.36 | $33.11 | $8,317.64 |
- 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
- $489.78 / $954.99 / $3,715.35
| Professional | | $489.78 | $954.99 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,148.15 / $3,981.07
| Professional | | $389.05 | $1,148.15 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,737.80 / $2,754.23
| Professional | | $467.74 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $8,317.64
| Facility | | $2,137.96 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,122.02 / $2,398.83
| Professional | | $363.08 | $1,122.02 | $2,398.83 |