- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $5,128.61 / $6,918.31
| Facility | | $501.19 | $5,128.61 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $1,023.29
| Professional | | $302.00 | $467.74 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $2,238.72 / $6,456.54
| Professional | | $354.81 | $2,238.72 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,174.90
| Professional | | $331.13 | $575.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,122.02
| Professional | | $512.86 | $741.31 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,489.63 / $26,302.68
| Facility | | $2,344.23 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $1,071.52
| Professional | | $295.12 | $549.54 | $1,071.52 |