- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,521.00 / $10,111.00
| Facility | | $2,073.00 | $4,521.00 | $10,111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.29 / $251.20 / $4,573.00
| Professional | | $152.29 | $251.20 | $4,573.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.59 / $4,605.95 / $8,070.83
| Facility | | $1,233.59 | $4,605.95 | $8,070.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.58 / $228.09 / $265.14
| Professional | | $199.58 | $228.09 | $265.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,350.00 / $6,742.00 / $9,010.00
| Facility | | $2,350.00 | $6,742.00 | $9,010.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,335.23 / $3,335.23 / $3,335.23
| Professional | | $3,335.23 | $3,335.23 | $3,335.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,350.00 / $6,230.00 / $9,010.00
| Facility | | $2,350.00 | $6,230.00 | $9,010.00 |