- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.57 / $3,392.50 / $8,074.63
| Facility | | $914.57 | $3,392.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.51 / $840.43 / $1,267.42
| Professional | | $722.51 | $840.43 | $1,267.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,247.00 / $8,800.00
| Facility | | $2,740.00 | $4,247.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.70 / $1,064.15 / $1,650.04
| Professional | | $840.70 | $1,064.15 | $1,650.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.25 / $2,617.17 / $3,088.67
| Facility | | $2,344.25 | $2,617.17 | $3,088.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.68 / $1,203.06 / $1,835.40
| Professional | | $842.68 | $1,203.06 | $1,835.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,951.00 / $7,934.00
| Facility | | $1,981.00 | $3,951.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.01 / $1,131.58 / $1,870.04
| Professional | | $802.01 | $1,131.58 | $1,870.04 |