- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,370.32 / $9,549.93
| Facility | | $1,288.25 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $1,949.84
| Professional | | $870.96 | $1,047.13 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,479.11 / $2,137.96
| Professional | | $954.99 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,659.59 / $2,511.89
| Facility | | $501.19 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $2,454.71
| Professional | | $1,000.00 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $5,370.32
| Professional | | $1,000.00 | $1,348.96 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,912.51 / $19,498.45
| Facility | | $2,290.87 | $8,912.51 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,230.27 / $2,187.76
| Professional | | $812.83 | $1,230.27 | $2,187.76 |