- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $9,772.37 / $22,387.21
| Facility | | $2,398.83 | $9,772.37 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $676.08 / $1,548.82
| Professional | | $208.93 | $676.08 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $691.83 / $2,691.53
| Professional | | $208.93 | $691.83 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,187.76 / $3,890.45
| Professional | | $478.63 | $2,187.76 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $1,318.26 / $3,162.28
| Professional | | $251.19 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,348.96 / $4,466.84
| Professional | | $331.13 | $1,348.96 | $4,466.84 |