- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,888.44 / $8,511.38
| Facility | | $1,258.93 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $5,011.87
| Professional | | $776.25 | $1,202.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,995.26
| Professional | | $812.83 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,698.24
| Professional | | $32.36 | $33.11 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $22,387.21
| Facility | | $8,317.64 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $2,290.87
| Professional | | $1,174.90 | $1,778.28 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,659.59 / $2,238.72
| Professional | | $812.83 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $2,137.96
| Professional | | $1,122.02 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $1,445.44
| Professional | | $741.31 | $954.99 | $1,445.44 |