- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,715.35 / $10,000.00
| Facility | | $478.63 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,122.02
| Professional | | $281.84 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $12,302.69
| Facility | | $2,041.74 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $831.76
| Professional | | $245.47 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,479.11 / $3,467.37
| Facility | | $524.81 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $1,174.90
| Professional | | $331.13 | $549.54 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,073.80 / $9,549.93
| Facility | | $1,318.26 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $457.09 / $870.96
| Professional | | $288.40 | $457.09 | $870.96 |