- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,570.88 / $10,471.29
| Facility | | $933.25 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $1,380.38
| Professional | | $660.69 | $794.33 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,467.37 / $4,168.69
| Facility | | $489.78 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,000.00 / $1,621.81
| Professional | | $645.65 | $1,000.00 | $1,621.81 |
- 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
- $436.52 / $602.56 / $912.01
| Professional | | $436.52 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,148.15
| Professional | | $32.36 | $33.11 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,762.47 / $12,022.64
| Facility | | $2,630.27 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,479.11
| Professional | | $575.44 | $812.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $794.33
| Professional | | $616.60 | $616.60 | $794.33 |