- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $10,964.78
| Facility | | $2,570.40 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $630.96
| Professional | | $234.42 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $467.74 / $954.99
| Professional | | $208.93 | $467.74 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $363.08 / $478.63
| Professional | | $316.23 | $363.08 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,022.64 / $19,054.61
| Facility | | $7,762.47 | $12,022.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $1,000.00
| Professional | | $208.93 | $338.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,413.10 / $15,135.61
| Facility | | $3,388.44 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $758.58
| Professional | | $208.93 | $389.05 | $758.58 |