- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,466.84 / $11,220.18
| Facility | | $660.69 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $1,047.13
| Professional | | $346.74 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $11,220.18
| Facility | | $2,290.87 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $933.25
| Professional | | $295.12 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,584.89 / $3,890.45
| Facility | | $616.60 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $1,348.96
| Professional | | $389.05 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,041.74 / $4,897.79
| Facility | | $645.65 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $1,000.00
| Professional | | $338.84 | $524.81 | $1,000.00 |