- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,677.35 / $8,511.38
| Facility | | $1,071.52 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $501.19 / $1,000.00
| Professional | | $162.18 | $501.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $562.34 / $1,737.80
| Professional | | $295.12 | $562.34 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,621.81
| Professional | | $251.19 | $588.84 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,318.26
| Professional | | $933.25 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $575.44 / $1,548.82
| Professional | | $190.55 | $575.44 | $1,548.82 |