- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,527.00 / $3,779.00
| Facility | | $400.00 | $1,527.00 | $3,779.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.23 / $2,575.53 / $4,151.20
| Professional | | $242.23 | $2,575.53 | $4,151.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.10 / $8,544.20 / $12,192.78
| Facility | | $4,783.10 | $8,544.20 | $12,192.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.19 / $468.69 / $3,747.41
| Professional | | $243.19 | $468.69 | $3,747.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,533.55 / $4,533.55 / $4,533.55
| Facility | | $4,533.55 | $4,533.55 | $4,533.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.15 / $1,937.06 / $4,686.64
| Professional | | $242.15 | $1,937.06 | $4,686.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,830.00 / $4,061.85 / $6,790.48
| Professional | | $2,830.00 | $4,061.85 | $6,790.48 |