- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.37 / $4,450.00 / $8,031.00
| Facility | | $689.37 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.24 / $390.99 / $915.20
| Professional | | $115.24 | $390.99 | $915.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,824.00 / $9,422.00 / $11,797.00
| Facility | | $7,824.00 | $9,422.00 | $11,797.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.90 / $331.87 / $979.14
| Professional | | $120.90 | $331.87 | $979.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.31 / $275.49 / $989.28
| Professional | | $132.31 | $275.49 | $989.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.16 / $571.16 / $611.72
| Professional | | $571.16 | $571.16 | $611.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,849.00 / $4,647.00 / $9,338.00
| Facility | | $1,849.00 | $4,647.00 | $9,338.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.03 / $756.76 / $1,400.26
| Professional | | $459.03 | $756.76 | $1,400.26 |