- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $9,120.11 / $10,715.19
| Facility | | $3,235.94 | $9,120.11 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,122.02 / $2,951.21
| Professional | | $346.74 | $1,122.02 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $3,235.94
| Professional | | $1,148.15 | $1,148.15 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,311.31 / $10,000.00
| Facility | | $407.38 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,238.72 / $5,888.44
| Professional | | $741.31 | $2,238.72 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $5,128.61
| Professional | | $1,318.26 | $2,290.87 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,630.27 / $7,079.46
| Facility | | $501.19 | $2,630.27 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $467.74 / $3,235.94
| Professional | | $60.26 | $467.74 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,698.24 / $3,890.45
| Professional | | $912.01 | $1,698.24 | $3,890.45 |