- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $12,022.64
| Facility | | $2,570.40 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,071.52 / $3,090.30
| Professional | | $295.12 | $1,071.52 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $309.03
| Professional | | $128.82 | $208.93 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,495.41 / $10,715.19
| Facility | | $1,995.26 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,202.26 / $2,754.23
| Professional | | $389.05 | $1,202.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $16,595.87 / $16,595.87
| Facility | | $15,488.17 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,000.00 / $3,467.37
| Professional | | $389.05 | $1,000.00 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,479.11 / $4,073.80
| Professional | | $309.03 | $1,479.11 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,089.30 / $2,454.71
| Professional | | $478.63 | $2,089.30 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,445.44 / $3,090.30
| Professional | | $331.13 | $1,445.44 | $3,090.30 |