- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.64 / $3,901.00 / $8,961.64
| Facility | | $833.64 | $3,901.00 | $8,961.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.42 / $499.23 / $772.93
| Professional | | $444.42 | $499.23 | $772.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,881.00 / $13,523.26
| Facility | | $3,248.00 | $5,881.00 | $13,523.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.55 / $618.60 / $987.84
| Professional | | $462.55 | $618.60 | $987.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.50 / $1,678.20 / $2,438.72
| Facility | | $842.50 | $1,678.20 | $2,438.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.06 / $699.23 / $1,059.89
| Professional | | $493.06 | $699.23 | $1,059.89 |
- 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
- $435.84 / $631.71 / $1,073.16
| Professional | | $435.84 | $631.71 | $1,073.16 |