- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $18,620.87
| Facility | | $4,570.88 | $9,772.37 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,995.26 / $8,912.51
| Facility | | $562.34 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $3,981.07
| Professional | | $562.34 | $562.34 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $16,982.44 / $50,118.72
| Facility | | $5,754.40 | $16,982.44 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,981.07 / $4,073.80
| Professional | | $3,715.35 | $3,981.07 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $4,466.84
| Professional | | $1,737.80 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $16,982.44 / $75,857.76
| Facility | | $363.08 | $16,982.44 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,890.45 / $4,365.16
| Professional | | $3,090.30 | $3,890.45 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $2,344.23 / $5,495.41
| Professional | | $416.87 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $1,096.48
| Facility | | $316.23 | $489.78 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,398.83 / $4,168.69
| Professional | | $812.83 | $2,398.83 | $4,168.69 |