- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,715.35 / $10,232.93
| Facility | | $630.96 | $3,715.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $575.44 / $1,230.27
| Professional | | $398.11 | $575.44 | $1,230.27 |
- 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
- $302.00 / $562.34 / $1,071.52
| Professional | | $302.00 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,513.56 / $4,365.16
| Facility | | $575.44 | $1,513.56 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $1,513.56
| Professional | | $436.52 | $707.95 | $1,513.56 |
- 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
- $380.19 / $588.84 / $1,122.02
| Professional | | $380.19 | $588.84 | $1,122.02 |