- 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
- $1,071.52 / $1,230.27 / $2,187.76
| Professional | | $1,071.52 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $2,041.74
| Facility | | $34.67 | $398.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,621.81 / $2,818.38
| Professional | | $1,000.00 | $1,621.81 | $2,818.38 |
- 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
- $776.25 / $831.76 / $1,288.25
| Professional | | $776.25 | $831.76 | $1,288.25 |
- 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
- $676.08 / $5,128.61 / $10,715.19
| Facility | | $676.08 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $2,511.89
| Professional | | $977.24 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,096.48
| Professional | | $912.01 | $912.01 | $1,096.48 |