- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,025.60 / $15,488.17
| Facility | | $1,819.70 | $6,025.60 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $7,413.10
| Professional | | $1,000.00 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,943.28 / $21,379.62
| Facility | | $2,630.27 | $7,943.28 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $8,709.64
| Professional | | $0.02 | $0.02 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $3,388.44 / $13,489.63
| Facility | | $199.53 | $3,388.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,630.78 / $6,165.95
| Professional | | $2,290.87 | $3,630.78 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $16,218.10
| Facility | | $1,778.28 | $6,606.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $53.70 / $63.10
| Professional | | $39.81 | $53.70 | $63.10 |