- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,466.84 / $10,232.93
| Facility | | $1,380.38 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $2,238.72
| Professional | | $1,071.52 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,025.60 / $7,762.47
| Facility | | $4,466.84 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,513.56 / $2,398.83
| Professional | | $1,096.48 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,445.44 / $2,290.87
| Professional | | $724.44 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $1,148.15 / $1,778.28
| Professional | | $13.18 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $11.48 / $1,778.28
| Professional | | $11.48 | $11.48 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $2,398.83
| Professional | | $1,174.90 | $1,174.90 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $6,606.93
| Facility | | $776.25 | $1,905.46 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $2,238.72
| Professional | | $1,000.00 | $1,348.96 | $2,238.72 |