- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.86 / $5,294.55 / $90,443.81
| Facility | | $1,194.86 | $5,294.55 | $90,443.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.70 / $566.44 / $668.40
| Professional | | $408.70 | $566.44 | $668.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.57 / $1,732.57 / $1,732.57
| Facility | | $1,732.57 | $1,732.57 | $1,732.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.14 / $579.63 / $1,187.34
| Professional | | $458.14 | $579.63 | $1,187.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.16 / $6,199.19 / $15,477.19
| Facility | | $3,420.16 | $6,199.19 | $15,477.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.83 / $900.79 / $3,846.27
| Professional | | $858.83 | $900.79 | $3,846.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,200.00
| Facility | | $2,200.00 | $2,200.00 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.40 / $653.37 / $1,534.02
| Professional | | $519.40 | $653.37 | $1,534.02 |