- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,715.35 / $9,772.37
| Facility | | $831.76 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $1,096.48
| Professional | | $389.05 | $467.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,071.52
| Professional | | $380.19 | $575.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,659.59 / $3,981.07
| Facility | | $776.25 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $1,445.44
| Professional | | $426.58 | $676.08 | $1,445.44 |
- 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
- $389.05 / $549.54 / $1,000.00
| Professional | | $389.05 | $549.54 | $1,000.00 |