- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.55 / $4,029.85 / $5,120.01
| Facility | | $328.55 | $4,029.85 | $5,120.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.25 / $1,836.42 / $4,774.68
| Professional | | $154.25 | $1,836.42 | $4,774.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.78 / $2,448.56 / $5,876.54
| Facility | | $795.78 | $2,448.56 | $5,876.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.07 / $9.07 / $1,268.34
| Professional | | $9.07 | $9.07 | $1,268.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.56 / $2,864.81 / $3,978.90
| Facility | | $1,591.56 | $2,864.81 | $3,978.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,982.60 / $2,982.60 / $3,573.49
| Professional | | $2,982.60 | $2,982.60 | $3,573.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,448.56 / $2,570.98
| Professional | | $2,448.56 | $2,448.56 | $2,570.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,028.40 / $2,448.56
| Professional | | $1,028.40 | $1,028.40 | $2,448.56 |