- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.18 / $3,916.11 / $4,816.80
| Facility | | $1,501.18 | $3,916.11 | $4,816.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.65 / $1,109.56 / $1,305.36
| Professional | | $887.65 | $1,109.56 | $1,305.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.48 / $3,916.11 / $7,086.85
| Facility | | $66.48 | $3,916.11 | $7,086.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.50 / $87.75 / $1,148.40
| Professional | | $56.50 | $87.75 | $1,148.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,631.71 / $28,775.48
| Facility | | $1,305.36 | $1,631.71 | $28,775.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,435.91 / $1,762.25
| Professional | | $1,305.36 | $1,435.91 | $1,762.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.49 / $2,467.40 / $5,091.37
| Facility | | $848.49 | $2,467.40 | $5,091.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.75 / $1,500.02 / $1,875.02
| Professional | | $87.75 | $1,500.02 | $1,875.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,305.36
| Professional | | $548.26 | $783.22 | $1,305.36 |