- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,981.07 / $8,709.64
| Facility | | $1,202.26 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $95.50 / $204.17
| Professional | | $79.43 | $95.50 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $109.65 / $154.88
| Professional | | $87.10 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $123.03 / $177.83
| Professional | | $100.00 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $575.44
| Professional | | $100.00 | $100.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $77.62
| Professional | | $70.79 | $70.79 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $12,882.50
| Facility | | $2,630.27 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $204.17
| Professional | | $95.50 | $128.82 | $204.17 |