- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.65 / $1,546.26 / $18,813.08
| Facility | | $601.65 | $1,546.26 | $18,813.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.48 / $712.99 / $1,171.70
| Professional | | $521.48 | $712.99 | $1,171.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,773.85 / $10,773.85 / $10,773.85
| Facility | | $10,773.85 | $10,773.85 | $10,773.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.66 / $803.47 / $1,492.07
| Professional | | $594.66 | $803.47 | $1,492.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,366.61 / $13,059.58 / $17,863.43
| Facility | | $6,366.61 | $13,059.58 | $17,863.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.38 / $1,125.58 / $1,312.22
| Professional | | $162.38 | $1,125.58 | $1,312.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,200.00
| Facility | | $2,200.00 | $2,200.00 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.13 / $944.17 / $2,402.64
| Professional | | $710.13 | $944.17 | $2,402.64 |