- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,388.44 / $6,025.60
| Facility | | $1,479.11 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,479.11 / $6,025.60
| Professional | | $912.01 | $1,479.11 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,570.40
| Professional | | $933.25 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,621.81
| Professional | | $32.36 | $33.11 | $1,621.81 |
- 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
- $1,412.54 / $1,905.46 / $2,511.89
| Professional | | $1,412.54 | $1,905.46 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,041.74 / $2,290.87
| Professional | | $1,000.00 | $2,041.74 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,778.28 / $2,691.53
| Professional | | $1,348.96 | $1,778.28 | $2,691.53 |
- 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
- $870.96 / $1,096.48 / $1,659.59
| Professional | | $870.96 | $1,096.48 | $1,659.59 |