- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.59 / $2,588.50 / $7,365.00
| Facility | | $429.59 | $2,588.50 | $7,365.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.77 / $426.38 / $612.61
| Professional | | $332.77 | $426.38 | $612.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.54 / $470.09 / $711.36
| Professional | | $385.54 | $470.09 | $711.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.07 / $568.41 / $968.91
| Professional | | $385.07 | $568.41 | $968.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.46 / $578.66 / $2,291.00
| Facility | | $331.46 | $578.66 | $2,291.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.65 / $731.30 / $3,427.04
| Professional | | $483.65 | $731.30 | $3,427.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.00 / $3,500.00 / $5,200.00
| Facility | | $1,742.00 | $3,500.00 | $5,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.00 / $622.41 / $998.98
| Professional | | $457.00 | $622.41 | $998.98 |