- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.80 / $3,606.50 / $8,340.00
| Facility | | $579.80 | $3,606.50 | $8,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.10 / $562.61 / $773.62
| Professional | | $465.10 | $562.61 | $773.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.32 / $2,937.55 / $10,382.04
| Facility | | $1,603.32 | $2,937.55 | $10,382.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.43 / $662.37 / $1,023.11
| Professional | | $465.43 | $662.37 | $1,023.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.40 / $807.40 / $1,578.55
| Facility | | $807.40 | $807.40 | $1,578.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.02 / $729.76 / $1,177.73
| Professional | | $524.02 | $729.76 | $1,177.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.76 / $704.96 / $1,191.35
| Professional | | $491.76 | $704.96 | $1,191.35 |