- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.91 / $1,517.00 / $9,034.00
| Facility | | $748.91 | $1,517.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.00 / $748.91 / $917.30
| Professional | | $509.00 | $748.91 | $917.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,555.03 / $3,555.03 / $4,266.04
| Facility | | $3,555.03 | $3,555.03 | $4,266.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.70 / $919.46 / $1,021.62
| Professional | | $694.70 | $919.46 | $1,021.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,708.38 / $2,708.38 / $2,708.38
| Facility | | $2,708.38 | $2,708.38 | $2,708.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.33 / $863.56 / $1,162.06
| Professional | | $482.33 | $863.56 | $1,162.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,268.00 / $5,626.00
| Facility | | $1,240.00 | $2,268.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.04 / $703.31 / $1,198.14
| Professional | | $551.04 | $703.31 | $1,198.14 |