- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,466.84 / $10,232.93
| Facility | | $616.60 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $1,023.29
| Professional | | $467.74 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,025.60 / $7,762.47
| Facility | | $4,466.84 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,071.52
| Professional | | $489.78 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,047.13
| Professional | | $407.38 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $537.03 / $851.14
| Professional | | $7.08 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $6.03 / $851.14
| Professional | | $6.03 | $6.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,071.52
| Professional | | $562.34 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $6,606.93
| Facility | | $776.25 | $1,905.46 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $1,000.00
| Professional | | $426.58 | $575.44 | $1,000.00 |