- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $12,022.64 / $18,197.01
| Facility | | $2,570.40 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $2,041.74
| Professional | | $831.76 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,778.28
| Professional | | $912.01 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $2,089.30
| Professional | | $977.24 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,290.87
| Facility | | $933.25 | $1,318.26 | $2,290.87 |
- 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
- $5,370.32 / $19,952.62 / $25,703.96
| Facility | | $5,370.32 | $19,952.62 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,862.09
| Professional | | $812.83 | $1,122.02 | $1,862.09 |