- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,398.83 / $9,772.37
| Facility | | $100.00 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $933.25
| Professional | | $407.38 | $616.60 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,471.29 / $19,952.62
| Facility | | $9,332.54 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $954.99 / $1,380.38
| Professional | | $416.87 | $954.99 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,288.25 / $1,445.44
| Professional | | $676.08 | $1,288.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $1,318.26
| Professional | | $489.78 | $851.14 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $2,089.30
| Professional | | $794.33 | $1,047.13 | $2,089.30 |