- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,897.79 / $8,511.38
| Facility | | $1,778.28 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $1,047.13
| Professional | | $575.44 | $912.01 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $1,380.38
| Professional | | $630.96 | $758.58 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $3,235.94
| Facility | | $588.84 | $588.84 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $691.83 / $831.76
| Professional | | $660.69 | $691.83 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,137.96 / $11,481.54
| Facility | | $630.96 | $2,137.96 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $7,079.46
| Professional | | $758.58 | $1,096.48 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $6,918.31
| Facility | | $2,454.71 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $1,380.38
| Professional | | $724.44 | $1,023.29 | $1,380.38 |