- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,520.00 / $3,728.00
| Facility | | $580.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.41 / $706.47 / $756.38
| Professional | | $465.41 | $706.47 | $756.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,991.07 / $5,894.91 / $9,116.19
| Facility | | $2,991.07 | $5,894.91 | $9,116.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.22 / $638.39 / $817.88
| Professional | | $602.22 | $638.39 | $817.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.96 / $580.55 / $782.71
| Professional | | $439.96 | $580.55 | $782.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.00 / $3,520.00 / $8,784.00
| Facility | | $1,027.00 | $3,520.00 | $8,784.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.02 / $589.91 / $943.16
| Professional | | $403.02 | $589.91 | $943.16 |