- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $512.86 / $7,079.46
| Facility | | $0.98 | $512.86 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,630.27 / $10,964.78
| Professional | | $457.09 | $2,630.27 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $645.65
| Professional | | $457.09 | $512.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $3,311.31
| Facility | | $512.86 | $645.65 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,548.82 / $11,748.98
| Professional | | $489.78 | $1,548.82 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,079.46 / $12,589.25
| Professional | | $5,754.40 | $7,079.46 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,000.00 / $3,548.13
| Facility | | $446.68 | $1,000.00 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $4,365.16 / $12,022.64
| Professional | | $446.68 | $4,365.16 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,079.46 / $9,549.93
| Professional | | $5,623.41 | $7,079.46 | $9,549.93 |