- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.13 / $488.44 / $3,525.17
| Facility | | $337.13 | $488.44 | $3,525.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.09 / $1,083.45 / $10,435.50
| Professional | | $383.09 | $1,083.45 | $10,435.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $8,107.00 / $14,586.00
| Facility | | $4,989.00 | $8,107.00 | $14,586.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.88 / $1,059.81 / $3,533.39
| Professional | | $257.88 | $1,059.81 | $3,533.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,259.31 / $4,202.75 / $8,549.40
| Facility | | $3,259.31 | $4,202.75 | $8,549.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.06 / $493.35 / $3,205.44
| Professional | | $350.06 | $493.35 | $3,205.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,334.00 / $4,334.00 / $4,334.00
| Facility | | $4,334.00 | $4,334.00 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.18 / $3,248.06 / $4,878.89
| Professional | | $1,797.18 | $3,248.06 | $4,878.89 |