- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,570.88 / $11,220.18
| Facility | | $977.24 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,548.82
| Professional | | $691.83 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,709.64 / $16,218.10
| Facility | | $3,235.94 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,659.59
| Professional | | $660.69 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,318.26 / $5,248.07
| Facility | | $323.59 | $1,318.26 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,023.29 / $2,137.96
| Professional | | $660.69 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,584.89
| Professional | | $630.96 | $870.96 | $1,584.89 |