- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.50 / $2,813.93 / $7,552.07
| Facility | | $578.50 | $2,813.93 | $7,552.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.13 / $863.70 / $1,523.87
| Professional | | $206.13 | $863.70 | $1,523.87 |
- 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
- $241.45 / $840.14 / $1,766.01
| Professional | | $241.45 | $840.14 | $1,766.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.96 / $336.96 / $336.96
| Facility | | $336.96 | $336.96 | $336.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.73 / $721.91 / $2,042.25
| Professional | | $241.73 | $721.91 | $2,042.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.50 / $5,179.00 / $9,412.00
| Facility | | $2,642.50 | $5,179.00 | $9,412.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.92 / $1,546.74 / $2,565.12
| Professional | | $1,029.92 | $1,546.74 | $2,565.12 |