- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,495.41 / $10,964.78
| Facility | | $1,148.15 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,137.96
| Professional | | $1,174.90 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $2,290.87
| Facility | | $34.67 | $398.11 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,819.70 / $3,162.28
| Professional | | $1,122.02 | $1,819.70 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $33,113.11
| Facility | | $9,332.54 | $21,379.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $912.01 / $1,548.82
| Professional | | $851.14 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,737.80
| Professional | | $32.36 | $33.11 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,248.07 / $22,387.21
| Facility | | $676.08 | $5,248.07 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $2,818.38
| Professional | | $1,096.48 | $1,621.81 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,230.27
| Professional | | $933.25 | $933.25 | $1,230.27 |