- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,365.16 / $10,715.19
| Facility | | $933.25 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $1,380.38
| Professional | | $524.81 | $645.65 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $12,302.69
| Facility | | $2,511.89 | $6,456.54 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,445.44
| Professional | | $489.78 | $758.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,949.84 / $5,370.32
| Facility | | $1,023.29 | $1,949.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $891.25 / $1,949.84
| Professional | | $549.54 | $891.25 | $1,949.84 |
- 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
- $489.78 / $707.95 / $1,318.26
| Professional | | $489.78 | $707.95 | $1,318.26 |