- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.14 / $1,868.02 / $5,313.35
| Facility | | $850.14 | $1,868.02 | $5,313.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $531.34 / $614.83
| Professional | | $531.34 | $531.34 | $614.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.64 / $1,387.54 / $2,960.30
| Facility | | $1,248.64 | $1,387.54 | $2,960.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.38 / $493.38 / $500.00
| Professional | | $493.38 | $493.38 | $500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.61 / $2,774.72 / $3,329.82
| Facility | | $1,370.61 | $2,774.72 | $3,329.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.05 / $1,030.18 / $2,342.81
| Professional | | $759.05 | $1,030.18 | $2,342.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $759.05
| Professional | | $318.80 | $455.43 | $759.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |