- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,388.44 / $6,025.60
| Facility | | $1,230.27 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,584.89
| Professional | | $707.95 | $891.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,096.48 / $1,230.27
| Professional | | $1,000.00 | $1,096.48 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,398.83
| Professional | | $32.36 | $33.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,623.41 / $12,589.25
| Facility | | $4,786.30 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,905.46 / $2,137.96
| Professional | | $954.99 | $1,905.46 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $1,995.26
| Professional | | $660.69 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $1,380.38
| Professional | | $1,000.00 | $1,174.90 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $8,317.64
| Facility | | $2,137.96 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,548.82
| Professional | | $724.44 | $954.99 | $1,548.82 |