- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.18 / $1,228.92 / $8,602.43
| Facility | | $478.18 | $1,228.92 | $8,602.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.18 / $631.73 / $802.73
| Professional | | $478.18 | $631.73 | $802.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.57 / $1,732.57 / $1,732.57
| Facility | | $1,732.57 | $1,732.57 | $1,732.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.75 / $686.67 / $1,247.45
| Professional | | $498.75 | $686.67 | $1,247.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,132.00 / $6,469.26 / $16,708.72
| Facility | | $6,132.00 | $6,469.26 | $16,708.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.08 / $911.67 / $1,049.07
| Professional | | $487.08 | $911.67 | $1,049.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,200.00
| Facility | | $2,200.00 | $2,200.00 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.62 / $732.03 / $1,656.36
| Professional | | $612.62 | $732.03 | $1,656.36 |