- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $8,511.38
| Facility | | $3,162.28 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $3,388.44
| Professional | | $512.86 | $776.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,412.54
| Professional | | $562.34 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,071.52
| Professional | | $32.36 | $33.11 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $12,302.69 / $28,183.83
| Facility | | $10,471.29 | $12,302.69 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $1,862.09
| Professional | | $794.33 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,122.02 / $1,258.93
| Professional | | $575.44 | $1,122.02 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $1,513.56
| Professional | | $758.58 | $1,000.00 | $1,513.56 |
- 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
- $501.19 / $616.60 / $954.99
| Professional | | $501.19 | $616.60 | $954.99 |