- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,888.44 / $8,511.38
| Facility | | $1,096.48 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,023.29 / $2,884.03
| Professional | | $933.25 | $1,023.29 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $1,659.59
| Professional | | $870.96 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,467.37
| Professional | | $32.36 | $33.11 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $22,387.21
| Facility | | $8,317.64 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $3,311.31
| Professional | | $1,230.27 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $2,511.89
| Professional | | $870.96 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $1,995.26
| Professional | | $1,230.27 | $1,513.56 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $1,445.44
| Professional | | $794.33 | $1,023.29 | $1,445.44 |