- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,244.36 / $10,000.00
| Facility | | $2,238.72 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $2,238.72
| Professional | | $1,445.44 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $346.74 / $1,000.00
| Professional | | $79.43 | $346.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,905.46 / $2,344.23
| Facility | | $1,698.24 | $1,905.46 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $870.96
| Professional | | $199.53 | $199.53 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $977.24 / $1,318.26
| Professional | | $39.81 | $977.24 | $1,318.26 |