- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,763.29
| Facility | | $1,000.00 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.69 / $2,482.38 / $10,171.10
| Professional | | $464.69 | $2,482.38 | $10,171.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,757.93 / $42,601.49 / $67,832.17
| Facility | | $17,757.93 | $42,601.49 | $67,832.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.42 / $6,913.64 / $11,103.59
| Professional | | $570.42 | $6,913.64 | $11,103.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.79 / $925.10 / $12,550.16
| Professional | | $560.79 | $925.10 | $12,550.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $5,586.94 / $9,638.92
| Professional | | $32.34 | $5,586.94 | $9,638.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.58 / $925.10 / $12,550.16
| Professional | | $571.58 | $925.10 | $12,550.16 |
- 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
- $9,587.16 / $11,766.06 / $17,213.32
| Professional | | $9,587.16 | $11,766.06 | $17,213.32 |