- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.67 / $1,674.17 / $7,227.39
| Facility | | $669.67 | $1,674.17 | $7,227.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.67 / $985.55 / $1,074.00
| Professional | | $669.67 | $985.55 | $1,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.09 / $1,866.65 / $3,979.03
| Facility | | $1,235.09 | $1,866.65 | $3,979.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.71 / $1,655.22 / $2,302.15
| Professional | | $1,326.71 | $1,655.22 | $2,302.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.47 / $884.47 / $8,702.00
| Facility | | $884.47 | $884.47 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.47 / $884.47 / $884.47
| Professional | | $884.47 | $884.47 | $884.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.67 / $758.12 / $1,288.80
| Professional | | $530.67 | $758.12 | $1,288.80 |