- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,025.60 / $8,709.64
| Facility | | $1,659.59 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $6,309.57
| Professional | | $1,071.52 | $1,479.11 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $2,754.23
| Professional | | $1,096.48 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,089.30
| Professional | | $32.36 | $33.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $12,022.64 / $26,302.68
| Facility | | $10,232.93 | $12,022.64 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,290.87 / $3,890.45
| Professional | | $1,513.56 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,137.96 / $2,818.38
| Professional | | $1,047.13 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $2,818.38
| Professional | | $1,445.44 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,128.61 / $15,848.93
| Facility | | $3,019.95 | $5,128.61 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,949.84
| Professional | | $1,000.00 | $1,258.93 | $1,949.84 |