- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,388.44 / $9,549.93
| Facility | | $602.56 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $1,000.00
| Professional | | $338.84 | $489.78 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $11,220.18
| Facility | | $1,819.70 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $1,047.13
| Professional | | $354.81 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,659.59 / $4,365.16
| Facility | | $588.84 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $1,230.27
| Professional | | $363.08 | $562.34 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $912.01
| Professional | | $316.23 | $489.78 | $912.01 |