- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $5,495.41 / $11,748.98
| Facility | | $794.33 | $5,495.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $616.60 / $2,089.30
| Professional | | $323.59 | $616.60 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,762.47 / $16,982.44
| Facility | | $2,884.03 | $7,762.47 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $630.96 / $1,230.27
| Professional | | $316.23 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,412.54 / $10,000.00
| Facility | | $602.56 | $1,412.54 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,230.27
| Professional | | $371.54 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,182.57
| Facility | | $1,995.26 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $954.99
| Professional | | $346.74 | $575.44 | $954.99 |