- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,890.45 / $10,715.19
| Facility | | $691.83 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $549.54 / $1,122.02
| Professional | | $257.04 | $549.54 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $1,230.27
| Professional | | $316.23 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,318.26 / $3,311.31
| Facility | | $446.68 | $1,318.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $724.44 / $1,288.25
| Professional | | $331.13 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,288.25
| Professional | | $457.09 | $707.95 | $1,288.25 |