- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,511.38 / $28,840.32
| Facility | | $4,466.84 | $8,511.38 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $3,548.13
| Professional | | $1,148.15 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $12,882.50 / $67,608.30
| Facility | | $2,187.76 | $12,882.50 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,621.81 / $3,162.28
| Professional | | $1,047.13 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,454.71
| Professional | | $1,318.26 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $5,011.87 / $21,877.62
| Facility | | $109.65 | $5,011.87 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $3,090.30
| Professional | | $1,047.13 | $1,479.11 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,912.51 / $36,307.81
| Facility | | $3,630.78 | $8,912.51 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,348.96 / $2,630.27
| Professional | | $870.96 | $1,348.96 | $2,630.27 |