- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $3,467.37 / $16,218.10
| Facility | | $338.84 | $3,467.37 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $977.24 / $2,089.30
| Professional | | $870.96 | $977.24 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,791.08 / $19,498.45
| Facility | | $6,456.54 | $14,791.08 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $1,995.26
| Professional | | $891.25 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $954.99 / $1,096.48
| Facility | | $870.96 | $954.99 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $1,995.26
| Professional | | $933.25 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $17,378.01
| Facility | | $5,011.87 | $11,481.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,778.28
| Professional | | $758.58 | $1,023.29 | $1,778.28 |