- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,884.03 / $10,471.29
| Facility | | $489.78 | $2,884.03 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $457.09 / $1,000.00
| Professional | | $144.54 | $457.09 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,000.00 / $16,982.44
| Facility | | $4,570.88 | $10,000.00 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $489.78 / $1,230.27
| Professional | | $151.36 | $489.78 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,548.82 / $15,135.61
| Facility | | $245.47 | $1,548.82 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $457.09 / $1,258.93
| Professional | | $173.78 | $457.09 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,801.89
| Facility | | $295.12 | $1,202.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $467.74 / $1,096.48
| Professional | | $151.36 | $467.74 | $1,096.48 |