- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.42 / $2,764.50 / $6,911.00
| Facility | | $533.42 | $2,764.50 | $6,911.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.68 / $457.04 / $878.02
| Professional | | $333.68 | $457.04 | $878.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.00 / $3,931.00 / $7,344.00
| Facility | | $2,385.00 | $3,931.00 | $7,344.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.64 / $465.06 / $759.18
| Professional | | $363.64 | $465.06 | $759.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.25 / $736.00 / $974.44
| Facility | | $625.25 | $736.00 | $974.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.73 / $585.91 / $997.11
| Professional | | $397.73 | $585.91 | $997.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,143.48 / $5,505.63
| Facility | | $1,380.00 | $3,143.48 | $5,505.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.01 / $609.47 / $1,044.13
| Professional | | $422.01 | $609.47 | $1,044.13 |