- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,778.28 / $3,388.44
| Facility | | $501.19 | $1,778.28 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $562.34 / $630.96
| Professional | | $295.12 | $562.34 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,786.30
| Facility | | $4,466.84 | $4,466.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $776.25 / $1,000.00
| Professional | | $724.44 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,778.28 / $4,073.80
| Facility | | $467.74 | $1,778.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,318.26
| Facility | | $537.03 | $645.65 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $724.44 / $870.96
| Facility | | $645.65 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $724.44
| Professional | | $302.00 | $436.52 | $724.44 |