- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,137.96 / $7,762.47
| Facility | | $1,047.13 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $1,000.00
| Professional | | $281.84 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $446.68
| Professional | | $371.54 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $2,187.76
| Professional | | $50.12 | $60.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $1,000.00
| Facility | | $363.08 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,096.48 / $1,412.54
| Facility | | $229.09 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $794.33
| Professional | | $389.05 | $562.34 | $794.33 |