- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,466.84 / $10,232.93
| Facility | | $1,122.02 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,122.02 / $2,454.71
| Professional | | $1,000.00 | $1,122.02 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $10,964.78
| Facility | | $5,370.32 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $2,137.96
| Professional | | $1,122.02 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $1,778.28
| Professional | | $851.14 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $1,071.52 / $1,621.81
| Professional | | $19.05 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $1,380.38
| Professional | | $16.60 | $16.60 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,023.29
| Professional | | $933.25 | $933.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $6,606.93
| Facility | | $1,071.52 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,318.26 / $1,862.09
| Professional | | $977.24 | $1,318.26 | $1,862.09 |