- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.36 / $3,351.71 / $7,972.21
| Facility | | $599.36 | $3,351.71 | $7,972.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.83 / $815.36 / $1,551.26
| Professional | | $316.83 | $815.36 | $1,551.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.00 / $3,693.00 / $8,517.00
| Facility | | $2,143.00 | $3,693.00 | $8,517.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.93 / $509.14 / $794.81
| Professional | | $383.93 | $509.14 | $794.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.44 / $1,747.94 / $1,935.22
| Facility | | $1,602.44 | $1,747.94 | $1,935.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.79 / $806.79 / $1,746.08
| Professional | | $379.79 | $806.79 | $1,746.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.00 / $2,665.00 / $5,510.00
| Facility | | $1,527.00 | $2,665.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.08 / $1,151.64 / $2,119.11
| Professional | | $797.08 | $1,151.64 | $2,119.11 |