- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.14 / $4,586.04 / $32,697.81
| Facility | | $532.14 | $4,586.04 | $32,697.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.15 / $688.82 / $1,250.89
| Professional | | $532.15 | $688.82 | $1,250.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.55 / $868.78 / $1,268.54
| Professional | | $698.55 | $868.78 | $1,268.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.79 / $1,072.45 / $1,525.82
| Professional | | $599.79 | $1,072.45 | $1,525.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.35 / $1,017.94 / $1,612.80
| Professional | | $829.35 | $1,017.94 | $1,612.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.04 / $4,586.04 / $32,697.81
| Facility | | $4,586.04 | $4,586.04 | $32,697.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.14 / $734.11 / $1,296.61
| Professional | | $532.14 | $734.11 | $1,296.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.86 / $1,072.30 / $1,556.50
| Professional | | $739.86 | $1,072.30 | $1,556.50 |