- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,897.79 / $7,413.10
| Facility | | $1,737.80 | $4,897.79 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $794.33 / $2,344.23
| Professional | | $114.82 | $794.33 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $11,748.98
| Facility | | $2,137.96 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $870.96 / $2,344.23
| Professional | | $162.18 | $870.96 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $478.63 / $2,754.23
| Professional | | $141.25 | $478.63 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $2,454.71
| Professional | | $1,445.44 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $4,168.69 / $7,762.47
| Facility | | $630.96 | $4,168.69 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $794.33 / $2,398.83
| Professional | | $114.82 | $794.33 | $2,398.83 |