- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $10,471.29
| Facility | | $1,412.54 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $537.03 / $1,513.56
| Professional | | $177.83 | $537.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $676.08 / $1,905.46
| Professional | | $194.98 | $676.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $891.25 / $1,380.38
| Professional | | $281.84 | $891.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $17,378.01
| Facility | | $7,244.36 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $676.08 / $1,513.56
| Professional | | $141.25 | $676.08 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $457.09 / $1,348.96
| Professional | | $138.04 | $457.09 | $1,348.96 |