- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,244.36 / $9,772.37
| Facility | | $1,000.00 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $1,412.54
| Professional | | $933.25 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,128.61 / $9,120.11
| Professional | | $2,818.38 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,548.82 / $2,454.71
| Professional | | $1,479.11 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $28,183.83
| Facility | | $3,311.31 | $16,218.10 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,778.28 / $3,311.31
| Professional | | $1,148.15 | $1,778.28 | $3,311.31 |