- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.51 / $3,826.00 / $6,915.00
| Facility | | $352.51 | $3,826.00 | $6,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.34 / $373.21 / $735.33
| Professional | | $249.34 | $373.21 | $735.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.09 / $2,795.56 / $6,315.83
| Facility | | $989.09 | $2,795.56 | $6,315.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.00 / $442.24 / $779.03
| Professional | | $293.00 | $442.24 | $779.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.12 / $394.99 / $771.71
| Professional | | $253.12 | $394.99 | $771.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.48 / $437.23 / $708.63
| Professional | | $314.48 | $437.23 | $708.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.48 / $463.34 / $676.12
| Professional | | $314.48 | $463.34 | $676.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,886.00 / $7,889.00
| Facility | | $1,200.00 | $4,886.00 | $7,889.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.64 / $504.96 / $910.35
| Professional | | $336.64 | $504.96 | $910.35 |