- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $7,015.29 / $9,327.21
| Facility | | $0.05 | $7,015.29 | $9,327.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,031.10 / $15,031.10 / $15,031.10
| Professional | | $15,031.10 | $15,031.10 | $15,031.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.05 / $6,118.28 / $9,692.21
| Facility | | $1,611.05 | $6,118.28 | $9,692.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.85 / $2,231.06 / $10,806.68
| Professional | | $1,533.85 | $2,231.06 | $10,806.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.32 / $4,102.57 / $6,837.62
| Facility | | $1,706.32 | $4,102.57 | $6,837.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.15 / $1,756.13 / $2,334.10
| Professional | | $1,037.15 | $1,756.13 | $2,334.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.65 / $2,805.18 / $4,675.30
| Facility | | $2,337.65 | $2,805.18 | $4,675.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.81 / $981.81 / $11,688.25
| Professional | | $981.81 | $981.81 | $11,688.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.89 / $2,103.89 / $2,805.18
| Facility | | $2,103.89 | $2,103.89 | $2,805.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.81 / $981.81 / $1,402.59
| Professional | | $981.81 | $981.81 | $1,402.59 |