- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.41 / $3,839.00 / $8,247.00
| Facility | | $360.41 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.65 / $305.75 / $770.48
| Professional | | $242.65 | $305.75 | $770.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $4,761.00 / $8,247.00
| Facility | | $657.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.65 / $360.41 / $807.62
| Professional | | $242.65 | $360.41 | $807.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.70 / $788.43 / $1,475.52
| Professional | | $429.70 | $788.43 | $1,475.52 |