- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $5,495.41 / $11,220.18
| Facility | | $501.19 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $1,288.25
| Professional | | $309.03 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $537.03 / $1,318.26
| Professional | | $323.59 | $537.03 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $645.65
| Professional | | $331.13 | $467.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,309.57 / $10,000.00
| Facility | | $3,981.07 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $1,513.56
| Professional | | $323.59 | $467.74 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $812.83
| Professional | | $229.09 | $426.58 | $812.83 |