- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,691.53 / $7,585.78
| Facility | | $1,819.70 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $758.58
| Professional | | $398.11 | $467.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,290.87 / $4,570.88
| Facility | | $954.99 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,000.00
| Professional | | $426.58 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $512.86 / $794.33
| Facility | | $501.19 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $954.99
| Professional | | $407.38 | $562.34 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $3,890.45 / $3,890.45
| Facility | | $54.95 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $3,715.35
| Professional | | $3,019.95 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $3,981.07
| Facility | | $1,000.00 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $831.76
| Professional | | $363.08 | $501.19 | $831.76 |