- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.64 / $1,218.00 / $3,804.00
| Facility | | $532.64 | $1,218.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.81 / $466.14 / $595.86
| Professional | | $367.81 | $466.14 | $595.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.70 / $607.12 / $642.83
| Professional | | $485.70 | $607.12 | $642.83 |
- 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
- $452.16 / $643.47 / $844.48
| Professional | | $452.16 | $643.47 | $844.48 |
- 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
- $404.52 / $599.00 / $887.47
| Professional | | $404.52 | $599.00 | $887.47 |