- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,754.40 / $11,481.54
| Facility | | $1,258.93 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $3,019.95
| Professional | | $1,202.26 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $10,000.00
| Facility | | $34.67 | $398.11 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $2,884.03
| Professional | | $1,096.48 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,445.44
| Professional | | $794.33 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,949.84
| Professional | | $32.36 | $33.11 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,570.40
| Professional | | $1,000.00 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,318.26
| Professional | | $1,047.13 | $1,047.13 | $1,318.26 |