- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,942.39
| Facility | | $1,000.00 | $7,838.38 | $8,942.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.06 / $1,647.53 / $7,355.27
| Professional | | $283.06 | $1,647.53 | $7,355.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,106.07 / $50,633.70 / $78,571.38
| Facility | | $21,106.07 | $50,633.70 | $78,571.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.41 / $4,683.35 / $6,671.86
| Professional | | $378.41 | $4,683.35 | $6,671.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.61 / $571.53 / $8,643.83
| Professional | | $333.61 | $571.53 | $8,643.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $3,357.05 / $5,735.51
| Professional | | $32.34 | $3,357.05 | $5,735.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.11 / $571.53 / $8,643.83
| Professional | | $348.11 | $571.53 | $8,643.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,609.00 / $21,608.00 / $23,186.00
| Facility | | $10,609.00 | $21,608.00 | $23,186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,943.20 / $8,487.12 / $11,852.71
| Professional | | $6,943.20 | $8,487.12 | $11,852.71 |