- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,025.60 / $9,332.54
| Facility | | $1,659.59 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $3,801.89
| Professional | | $1,318.26 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,905.46 / $3,311.31
| Professional | | $1,148.15 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $6,606.93
| Professional | | $32.36 | $33.11 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $22,387.21
| Facility | | $8,317.64 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,570.40 / $3,388.44
| Professional | | $2,041.74 | $2,570.40 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,818.38 / $3,801.89
| Professional | | $1,318.26 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $3,715.35
| Professional | | $1,862.09 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,698.24 / $3,162.28
| Professional | | $1,380.38 | $1,698.24 | $3,162.28 |