- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.31 / $2,906.41 / $7,444.12
| Facility | | $510.31 | $2,906.41 | $7,444.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.66 / $441.93 / $809.23
| Professional | | $294.66 | $441.93 | $809.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.94 / $459.62 / $696.05
| Professional | | $325.94 | $459.62 | $696.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.97 / $1,547.95 / $2,070.38
| Facility | | $714.97 | $1,547.95 | $2,070.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.62 / $556.31 / $965.74
| Professional | | $369.62 | $556.31 | $965.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.00 / $3,764.00 / $7,934.00
| Facility | | $1,832.00 | $3,764.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.41 / $607.55 / $1,072.73
| Professional | | $421.41 | $607.55 | $1,072.73 |