- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,754.40 / $16,982.44
| Facility | | $1,380.38 | $5,754.40 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $512.86 / $2,818.38
| Professional | | $223.87 | $512.86 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $204.17 / $302.00
| Professional | | $104.71 | $204.17 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,762.47 / $12,302.69
| Facility | | $5,011.87 | $7,762.47 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $1,995.26 / $2,754.23
| Professional | | $239.88 | $1,995.26 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,621.81 / $2,511.89
| Professional | | $295.12 | $1,621.81 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,398.83 / $8,709.64
| Facility | | $269.15 | $2,398.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $15,488.17
| Professional | | $1,621.81 | $2,344.23 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,511.38
| Facility | | $1,230.27 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,230.27 / $2,511.89
| Professional | | $234.42 | $1,230.27 | $2,511.89 |