- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,471.29 / $18,197.01
| Facility | | $2,454.71 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $2,137.96
| Professional | | $851.14 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $19,498.45 / $32,359.37
| Facility | | $4,786.30 | $19,498.45 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $831.76 / $1,148.15
| Professional | | $776.25 | $831.76 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $2,041.74
| Professional | | $891.25 | $1,174.90 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $2,089.30
| Facility | | $912.01 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,890.45 / $26,302.68
| Facility | | $1,122.02 | $3,890.45 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,047.13 / $1,862.09
| Professional | | $812.83 | $1,047.13 | $1,862.09 |