- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,165.95 / $14,791.08
| Facility | | $1,071.52 | $6,165.95 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,202.26 / $7,244.36
| Professional | | $309.03 | $1,202.26 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,964.78 / $23,988.33
| Facility | | $3,715.35 | $10,964.78 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $4,466.84 / $10,715.19
| Professional | | $302.00 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $11,481.54 / $33,884.42
| Facility | | $338.84 | $11,481.54 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,479.11 / $11,748.98
| Professional | | $354.81 | $1,479.11 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,915.35
| Facility | | $3,630.78 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $4,073.80 / $10,000.00
| Professional | | $323.59 | $4,073.80 | $10,000.00 |