- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,495.41 / $10,964.78
| Facility | | $1,096.48 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,290.87
| Professional | | $1,047.13 | $1,288.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $3,801.89
| Facility | | $323.59 | $501.19 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $2,630.27
| Professional | | $954.99 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $33,113.11
| Facility | | $9,332.54 | $21,379.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $1,445.44
| Professional | | $616.60 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,479.11
| Professional | | $32.36 | $33.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,011.87 / $10,715.19
| Facility | | $616.60 | $5,011.87 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $2,187.76
| Professional | | $912.01 | $1,258.93 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,202.26
| Professional | | $851.14 | $851.14 | $1,202.26 |