- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.22 / $4,396.00 / $10,300.00
| Facility | | $279.22 | $4,396.00 | $10,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.80 / $279.22 / $348.81
| Professional | | $192.80 | $279.22 | $348.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $5,379.00 / $8,190.00
| Facility | | $4,452.00 | $5,379.00 | $8,190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.76 / $313.68 / $459.02
| Professional | | $272.76 | $313.68 | $459.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,646.46 / $2,646.46 / $2,646.46
| Facility | | $2,646.46 | $2,646.46 | $2,646.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.30 / $2,455.12 / $3,125.29
| Professional | | $406.30 | $2,455.12 | $3,125.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,177.96 / $5,177.96 / $5,177.96
| Facility | | $5,177.96 | $5,177.96 | $5,177.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,042.00 / $4,794.00 / $10,407.00
| Facility | | $2,042.00 | $4,794.00 | $10,407.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.07 / $375.48 / $541.36
| Professional | | $257.07 | $375.48 | $541.36 |