- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.16 / $2,497.85 / $3,159.44
| Facility | | $1,161.16 | $2,497.85 | $3,159.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.11 / $1,107.16 / $1,716.10
| Professional | | $810.11 | $1,107.16 | $1,716.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.75 / $5,811.64 / $17,861.18
| Facility | | $1,822.75 | $5,811.64 | $17,861.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $931.63 / $1,039.65
| Professional | | $3.50 | $931.63 | $1,039.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.33 / $3,354.47 / $6,215.38
| Facility | | $1,516.33 | $3,354.47 | $6,215.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.96 / $1,567.16 / $2,278.96
| Professional | | $658.96 | $1,567.16 | $2,278.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.19 / $2,160.30 / $3,489.53
| Professional | | $1,350.19 | $2,160.30 | $3,489.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.25 / $1,755.25 / $1,755.25
| Professional | | $1,755.25 | $1,755.25 | $1,755.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.10 / $1,350.19 / $1,984.78
| Professional | | $675.10 | $1,350.19 | $1,984.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.08 / $810.11 / $1,350.19
| Professional | | $567.08 | $810.11 | $1,350.19 |