- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,677.35 / $10,964.78
| Facility | | $1,202.26 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $575.44
| Professional | | $323.59 | $467.74 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,220.18 / $26,915.35
| Facility | | $4,786.30 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $1,000.00
| Professional | | $407.38 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $50,118.72
| Facility | | $794.33 | $794.33 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $2,238.72
| Professional | | $630.96 | $912.01 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $25,703.96
| Facility | | $3,630.78 | $10,964.78 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $1,148.15
| Professional | | $436.52 | $630.96 | $1,148.15 |