- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.78 / $945.60 / $5,748.38
| Facility | | $568.78 | $945.60 | $5,748.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.11 / $2,271.78 / $6,758.96
| Professional | | $647.11 | $2,271.78 | $6,758.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,304.24 / $5,304.24 / $6,365.09
| Facility | | $5,304.24 | $5,304.24 | $6,365.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.66 / $627.44 / $3,697.28
| Professional | | $426.66 | $627.44 | $3,697.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.13 / $426.13 / $426.13
| Professional | | $426.13 | $426.13 | $426.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,334.00 / $4,334.00 / $4,334.00
| Facility | | $4,334.00 | $4,334.00 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,049.08 / $4,815.89 / $6,493.99
| Professional | | $3,049.08 | $4,815.89 | $6,493.99 |