- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.63 / $3,286.50 / $8,094.57
| Facility | | $702.63 | $3,286.50 | $8,094.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.12 / $670.37 / $1,088.04
| Professional | | $533.12 | $670.37 | $1,088.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,675.00 / $4,133.00 / $8,800.00
| Facility | | $2,675.00 | $4,133.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.44 / $724.15 / $1,221.32
| Professional | | $544.44 | $724.15 | $1,221.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.23 / $1,389.94 / $1,918.46
| Facility | | $910.23 | $1,389.94 | $1,918.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.53 / $882.74 / $1,432.65
| Professional | | $598.53 | $882.74 | $1,432.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $4,800.83 / $8,510.56
| Facility | | $1,981.00 | $4,800.83 | $8,510.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.90 / $858.41 / $1,520.89
| Professional | | $601.90 | $858.41 | $1,520.89 |