- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.74 / $4,147.50 / $8,561.00
| Facility | | $974.74 | $4,147.50 | $8,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.34 / $686.73 / $1,075.98
| Professional | | $584.34 | $686.73 | $1,075.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,136.00
| Facility | | $3,248.00 | $5,196.00 | $11,136.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.32 / $915.43 / $1,361.44
| Professional | | $630.32 | $915.43 | $1,361.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $2,055.51 / $3,851.90
| Facility | | $1,040.00 | $2,055.51 | $3,851.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.41 / $972.49 / $1,451.77
| Professional | | $679.41 | $972.49 | $1,451.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.08 / $868.19 / $1,458.27
| Professional | | $602.08 | $868.19 | $1,458.27 |