- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $8,709.64
| Facility | | $1,148.15 | $1,819.70 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $3,162.28
| Professional | | $1,047.13 | $1,348.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $2,951.21
| Professional | | $1,380.38 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $2,818.38
| Professional | | $1,258.93 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $2,290.87
| Facility | | $1,148.15 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $1,949.84 / $2,691.53
| Professional | | $7.94 | $1,949.84 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,232.93 / $14,454.40
| Facility | | $3,548.13 | $10,232.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,630.27
| Professional | | $1,047.13 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $12,302.69 / $12,302.69
| Facility | | $56.23 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Professional | | $10,232.93 | $10,232.93 | $10,232.93 |