- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $9,332.54
| Facility | | $3,162.28 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $954.99
| Professional | | $478.63 | $602.56 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,202.26
| Professional | | $616.60 | $776.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,981.07
| Professional | | $32.36 | $33.11 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $19,498.45
| Facility | | $7,244.36 | $8,511.38 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $3,890.45
| Professional | | $724.44 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $870.96 / $1,122.02
| Professional | | $478.63 | $870.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,202.26
| Professional | | $691.83 | $851.14 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $7,079.46
| Facility | | $1,995.26 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,122.02
| Professional | | $501.19 | $602.56 | $1,122.02 |