- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.45 / $1,913.97 / $2,279.98
| Professional | | $168.45 | $1,913.97 | $2,279.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.40 / $373.43 / $2,919.46
| Professional | | $226.40 | $373.43 | $2,919.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,451.94 / $2,554.26
| Professional | | $32.34 | $1,451.94 | $2,554.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.02 / $247.02 / $2,100.66
| Facility | | $247.02 | $247.02 | $2,100.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.40 / $373.43 / $3,012.23
| Professional | | $226.40 | $373.43 | $3,012.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.00 / $1,327.00 / $1,327.00
| Facility | | $775.00 | $1,327.00 | $1,327.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,203.96 / $2,665.31 / $3,837.55
| Professional | | $2,203.96 | $2,665.31 | $3,837.55 |