- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,912.51 / $22,387.21
| Facility | | $3,467.37 | $8,912.51 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,122.02 / $8,317.64
| Professional | | $316.23 | $1,122.02 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $13,803.84 / $48,977.88
| Facility | | $3,311.31 | $13,803.84 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $5,370.32 / $14,791.08
| Facility | | $66.07 | $5,370.32 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $13,489.63 / $14,791.08
| Facility | | $11,748.98 | $13,489.63 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $398.11 / $1,698.24
| Professional | | $141.25 | $398.11 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,232.93 / $10,232.93
| Facility | | $2,818.38 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $2,951.21
| Professional | | $1,995.26 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,489.63 / $14,791.08
| Facility | | $13,182.57 | $13,489.63 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Professional | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $25,703.96
| Facility | | $6,760.83 | $12,302.69 | $25,703.96 |