- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $4,897.79 / $14,125.38
| Facility | | $741.31 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $1,288.25
| Professional | | $524.81 | $616.60 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $23,988.33 / $33,113.11
| Facility | | $4,365.16 | $23,988.33 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,122.02
| Professional | | $549.54 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $549.54 / $616.60
| Facility | | $524.81 | $549.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,148.15
| Facility | | $549.54 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $1,202.26
| Professional | | $524.81 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $977.24
| Professional | | $489.78 | $616.60 | $977.24 |