- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,000.00 / $7,244.36
| Facility | | $426.58 | $1,000.00 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $1,148.15
| Professional | | $398.11 | $588.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,348.96
| Professional | | $436.52 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,258.93
| Professional | | $436.52 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,047.13
| Facility | | $426.58 | $645.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,244.36 / $10,471.29
| Facility | | $1,995.26 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $1,122.02
| Professional | | $398.11 | $562.34 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $28,840.32
| Facility | | $5,754.40 | $5,754.40 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,128.61 / $5,128.61
| Professional | | $4,897.79 | $5,128.61 | $5,128.61 |