- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,388.44 / $6,025.60
| Facility | | $676.08 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $630.96 / $776.25
| Professional | | $239.88 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $1,000.00
| Professional | | $30.20 | $44.67 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,943.28 / $17,782.79
| Facility | | $6,760.83 | $7,943.28 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $851.14 / $1,047.13
| Professional | | $263.03 | $851.14 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $501.19 / $1,096.48
| Professional | | $457.09 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $316.23 / $363.08
| Professional | | $295.12 | $316.23 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $724.44 / $1,288.25
| Professional | | $331.13 | $724.44 | $1,288.25 |