- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $7,943.28 / $9,549.93
| Facility | | $794.33 | $7,943.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $1,737.80
| Professional | | $691.83 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,412.54
| Professional | | $602.56 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $30,199.52
| Facility | | $9,549.93 | $9,549.93 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $6,165.95 / $6,309.57
| Professional | | $794.33 | $6,165.95 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,479.11
| Facility | | $1,000.00 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $1,288.25
| Professional | | $645.65 | $812.83 | $1,288.25 |