- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $7,079.46
| Facility | | $2,238.72 | $3,388.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $2,344.23 / $5,011.87
| Professional | | $158.49 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $2,570.40 / $4,897.79
| Professional | | $208.93 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $12,882.50
| Professional | | $32.36 | $33.11 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $22,387.21
| Facility | | $8,317.64 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $5,248.07
| Professional | | $234.42 | $371.54 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $2,398.83 / $4,677.35
| Professional | | $186.21 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $3,467.37 / $5,370.32
| Professional | | $229.09 | $3,467.37 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $2,344.23 / $5,623.41
| Professional | | $173.78 | $2,344.23 | $5,623.41 |