- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,398.83 / $22,387.21
| Facility | | $346.74 | $2,398.83 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $954.99 / $1,862.09
| Professional | | $295.12 | $954.99 | $1,862.09 |
- 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
- $263.03 / $851.14 / $2,951.21
| Professional | | $263.03 | $851.14 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,995.26 / $4,168.69
| Professional | | $602.56 | $1,995.26 | $4,168.69 |
- 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
- $316.23 / $1,445.44 / $3,467.37
| Professional | | $316.23 | $1,445.44 | $3,467.37 |
- 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
- $436.52 / $1,659.59 / $5,128.61
| Professional | | $436.52 | $1,659.59 | $5,128.61 |