- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,466.84 / $5,495.41
| Facility | | $4,365.16 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,380.38 / $2,951.21
| Professional | | $371.54 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,623.41 / $12,882.50
| Facility | | $2,041.74 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $2,511.89 / $3,090.30
| Professional | | $645.65 | $2,511.89 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $724.44 / $3,162.28
| Professional | | $398.11 | $724.44 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,398.83 / $4,570.88
| Facility | | $489.78 | $2,398.83 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,819.70 / $3,235.94
| Professional | | $407.38 | $1,819.70 | $3,235.94 |
- 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
- $8,912.51 / $11,220.18 / $16,218.10
| Facility | | $8,912.51 | $11,220.18 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $2,818.38
| Professional | | $489.78 | $676.08 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,479.11 / $11,748.98
| Professional | | $645.65 | $1,479.11 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $11,220.18 / $19,952.62
| Facility | | $10,232.93 | $11,220.18 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,513.56 / $3,467.37
| Professional | | $389.05 | $1,513.56 | $3,467.37 |