- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $3,592.07 / $7,500.00
| Facility | | $750.00 | $3,592.07 | $7,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.55 / $2,911.75 / $3,592.07
| Professional | | $168.55 | $2,911.75 | $3,592.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,198.18 / $19,015.74 / $29,923.83
| Facility | | $12,198.18 | $19,015.74 | $29,923.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.72 / $3,472.95 / $3,972.64
| Professional | | $198.72 | $3,472.95 | $3,972.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.86 / $256.14 / $3,982.77
| Professional | | $192.86 | $256.14 | $3,982.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.55 / $3,057.34 / $10,701.05
| Facility | | $168.55 | $3,057.34 | $10,701.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,828.74 / $4,745.99 / $20,949.68
| Professional | | $2,828.74 | $4,745.99 | $20,949.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.00 / $6,980.00 / $13,541.98
| Facility | | $1,570.00 | $6,980.00 | $13,541.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,645.62 / $3,910.39 / $5,590.44
| Professional | | $2,645.62 | $3,910.39 | $5,590.44 |