- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.52 / $1,517.00 / $9,034.00
| Facility | | $790.52 | $1,517.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.49 / $757.37 / $926.21
| Professional | | $590.49 | $757.37 | $926.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.59 / $881.99 / $933.87
| Professional | | $705.59 | $881.99 | $933.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.07 / $3,206.07 / $3,206.07
| Facility | | $3,206.07 | $3,206.07 | $3,206.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.84 / $969.90 / $1,233.22
| Professional | | $714.84 | $969.90 | $1,233.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,626.00
| Facility | | $1,240.00 | $2,311.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.04 / $804.85 / $1,245.25
| Professional | | $583.04 | $804.85 | $1,245.25 |