- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,834.13 / $6,094.04 / $13,841.56
| Facility | | $2,834.13 | $6,094.04 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.00 / $1,161.00 / $11,100.08
| Professional | | $680.00 | $1,161.00 | $11,100.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.74 / $173.74 / $217.17
| Professional | | $173.74 | $173.74 | $217.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.62 / $1,242.00 / $4,406.00
| Facility | | $298.62 | $1,242.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,325.39 / $3,325.39 / $3,325.39
| Professional | | $3,325.39 | $3,325.39 | $3,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |