- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,370.32 / $22,387.21
| Facility | | $2,398.83 | $5,370.32 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $660.69 / $1,122.02
| Professional | | $457.09 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $12,022.64 / $22,908.68
| Facility | | $10,964.78 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,000.00 / $1,380.38
| Professional | | $489.78 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,819.70 / $2,951.21
| Professional | | $1,000.00 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $3,235.94
| Professional | | $794.33 | $1,174.90 | $3,235.94 |