- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,715.35 / $10,000.00
| Facility | | $831.76 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $446.68 / $1,071.52
| Professional | | $371.54 | $446.68 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,079.46 / $29,512.09
| Facility | | $2,570.40 | $7,079.46 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,023.29
| Professional | | $354.81 | $512.86 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,445.44 / $17,782.79
| Facility | | $741.31 | $1,445.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,348.96
| Professional | | $398.11 | $602.56 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $16,982.44 / $42,657.95
| Facility | | $4,897.79 | $16,982.44 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $933.25
| Professional | | $338.84 | $501.19 | $933.25 |