- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,388.44 / $10,000.00
| Facility | | $501.19 | $3,388.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,584.89 / $5,623.41
| Professional | | $204.17 | $1,584.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $13,803.84
| Facility | | $2,570.40 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $5,888.44
| Professional | | $213.80 | $363.08 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $8,317.64 / $21,877.62
| Facility | | $34.67 | $8,317.64 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $1,000.00 / $7,943.28
| Professional | | $245.47 | $1,000.00 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,288.25 / $10,471.29
| Facility | | $269.15 | $1,288.25 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $2,454.71 / $6,918.31
| Professional | | $208.93 | $2,454.71 | $6,918.31 |