- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,025.60 / $8,709.64
| Facility | | $1,096.48 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,905.46
| Professional | | $645.65 | $851.14 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $1,698.24
| Professional | | $549.54 | $977.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,548.82
| Professional | | $32.36 | $33.11 | $1,548.82 |
- 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
- $891.25 / $1,258.93 / $1,698.24
| Professional | | $891.25 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $1,698.24
| Professional | | $758.58 | $1,288.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,698.24
| Professional | | $831.76 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $7,079.46
| Facility | | $1,995.26 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,412.54
| Professional | | $616.60 | $831.76 | $1,412.54 |