- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,760.83 / $14,454.40
| Facility | | $1,445.44 | $6,760.83 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,698.24 / $5,128.61
| Professional | | $169.82 | $1,698.24 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $269.15 / $1,174.90
| Professional | | $97.72 | $269.15 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $11,748.98 / $53,703.18
| Facility | | $398.11 | $11,748.98 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,513.56
| Professional | | $1,445.44 | $1,445.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $977.24 / $1,513.56
| Professional | | $39.81 | $977.24 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,000.00 / $15,848.93
| Facility | | $2,818.38 | $10,000.00 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $60.26
| Professional | | $34.67 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |