- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $11,481.54
| Facility | | $1,047.13 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,230.27
| Professional | | $478.63 | $794.33 | $1,230.27 |
- 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
- $549.54 / $812.83 / $1,412.54
| Professional | | $549.54 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,317.64 / $16,595.87
| Facility | | $4,365.16 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $602.56 / $758.58
| Professional | | $562.34 | $602.56 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $776.25
| Professional | | $32.36 | $33.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $831.76 / $1,548.82
| Professional | | $512.86 | $831.76 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |