- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,344.23 / $4,897.79
| Facility | | $691.83 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $1,380.38
| Professional | | $630.96 | $724.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $26,915.35 / $36,307.81
| Facility | | $10,232.93 | $26,915.35 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,023.29 / $1,548.82
| Professional | | $602.56 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $660.69 / $707.95
| Facility | | $602.56 | $660.69 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $831.76 / $1,348.96
| Professional | | $645.65 | $831.76 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,288.25
| Professional | | $575.44 | $794.33 | $1,288.25 |