- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,495.41 / $10,964.78
| Facility | | $1,230.27 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,677.35 / $7,413.10
| Professional | | $1,621.81 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $10,000.00
| Facility | | $34.67 | $398.11 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,011.87 / $9,120.11
| Professional | | $2,137.96 | $5,011.87 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $33,113.11
| Facility | | $9,332.54 | $21,379.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,090.30 / $3,467.37
| Professional | | $2,884.03 | $3,090.30 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $4,897.79
| Professional | | $32.36 | $33.11 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,128.61 / $10,715.19
| Facility | | $676.08 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,677.35 / $9,120.11
| Professional | | $1,659.59 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |