- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,370.32 / $7,413.10
| Facility | | $676.08 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,288.25
| Professional | | $489.78 | $676.08 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,454.71 / $4,786.30
| Facility | | $1,000.00 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $724.44 / $1,023.29
| Professional | | $398.11 | $724.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $954.99 / $1,000.00
| Facility | | $831.76 | $954.99 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $1,479.11
| Professional | | $501.19 | $794.33 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $891.25 / $4,365.16
| Professional | | $676.08 | $891.25 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,348.96
| Professional | | $446.68 | $645.65 | $1,348.96 |