- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.20 / $476.44 / $3,158.03
| Facility | | $460.20 | $476.44 | $3,158.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.47 / $4,251.78 / $8,298.58
| Professional | | $591.47 | $4,251.78 | $8,298.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.51 / $812.12 / $3,337.46
| Professional | | $503.51 | $812.12 | $3,337.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,855.00 / $12,685.00 / $23,031.00
| Facility | | $5,855.00 | $12,685.00 | $23,031.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,512.07 / $2,691.50 / $5,621.06
| Professional | | $2,512.07 | $2,691.50 | $5,621.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,760.39 / $4,127.84 / $5,463.52
| Professional | | $2,760.39 | $4,127.84 | $5,463.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,134.27 / $6,050.36 / $10,492.56
| Professional | | $4,134.27 | $6,050.36 | $10,492.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.90 / $2,961.76 / $2,961.76
| Professional | | $402.90 | $2,961.76 | $2,961.76 |