- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,466.84 / $10,232.93
| Facility | | $1,230.27 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,288.25 / $2,238.72
| Professional | | $1,148.15 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,128.31 / $10,000.00
| Facility | | $4,677.35 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,778.28 / $2,511.89
| Professional | | $1,348.96 | $1,778.28 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $2,137.96
| Professional | | $1,047.13 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $1,380.38 / $1,995.26
| Professional | | $16.98 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $14.45 / $1,819.70
| Professional | | $14.45 | $14.45 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,258.93
| Professional | | $1,202.26 | $1,202.26 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,754.40 / $14,791.08
| Facility | | $3,715.35 | $5,754.40 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,238.72
| Professional | | $1,096.48 | $1,445.44 | $2,238.72 |