- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,248.07 / $13,182.57
| Facility | | $2,398.83 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,047.13 / $3,715.35
| Professional | | $389.05 | $1,047.13 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $31,622.78
| Facility | | $8,912.51 | $17,378.01 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $912.01 / $3,388.44
| Professional | | $478.63 | $912.01 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $13,803.84
| Facility | | $2,187.76 | $2,187.76 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $5,248.07
| Professional | | $588.84 | $1,047.13 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $7,079.46
| Facility | | $6,918.31 | $6,918.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $4,897.79
| Professional | | $537.03 | $724.44 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $20,892.96
| Facility | | $7,244.36 | $11,220.18 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,318.26 / $4,786.30
| Professional | | $389.05 | $1,318.26 | $4,786.30 |