- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $9,332.54
| Facility | | $812.83 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $562.34 / $1,148.15
| Professional | | $478.63 | $562.34 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,365.16 / $10,000.00
| Facility | | $1,905.46 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,318.26
| Professional | | $467.74 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,318.26 / $3,890.45
| Facility | | $616.60 | $1,318.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,698.24
| Professional | | $524.81 | $776.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $1,148.15
| Professional | | $446.68 | $616.60 | $1,148.15 |