- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $12,022.64 / $18,197.01
| Facility | | $2,454.71 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $2,089.30
| Professional | | $794.33 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $691.83 / $1,288.25
| Professional | | $676.08 | $691.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $8,511.38
| Facility | | $6,606.93 | $6,606.93 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $912.01 / $1,659.59
| Professional | | $812.83 | $912.01 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,949.84
| Professional | | $912.01 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,089.30
| Facility | | $851.14 | $1,258.93 | $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
- $3,090.30 / $12,882.50 / $23,442.29
| Facility | | $3,090.30 | $12,882.50 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,698.24
| Professional | | $812.83 | $1,096.48 | $1,698.24 |