- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.75 / $3,606.50 / $8,074.63
| Facility | | $614.75 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.51 / $589.72 / $814.45
| Professional | | $496.51 | $589.72 | $814.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $11,253.00
| Facility | | $3,302.10 | $6,548.00 | $11,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.56 / $672.15 / $1,075.38
| Professional | | $500.56 | $672.15 | $1,075.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.07 / $821.07 / $1,611.67
| Facility | | $821.07 | $821.07 | $1,611.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.08 / $767.14 / $1,252.34
| Professional | | $569.08 | $767.14 | $1,252.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.45 / $734.68 / $1,291.18
| Professional | | $520.45 | $734.68 | $1,291.18 |