- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $14,454.40
| Facility | | $2,344.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $2,290.87 / $8,912.51
| Professional | | $64.57 | $2,290.87 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $269.15 / $467.74
| Facility | | $120.23 | $269.15 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Professional | | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $100.00 / $4,073.80
| Facility | | $64.57 | $100.00 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $100.00 / $4,073.80
| Professional | | $64.57 | $100.00 | $4,073.80 |