- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,715.35 / $9,549.93
| Facility | | $933.25 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,412.54
| Professional | | $537.03 | $645.65 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $11,481.54 / $25,703.96
| Facility | | $3,090.30 | $11,481.54 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,513.56
| Professional | | $489.78 | $758.58 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,659.59 / $4,897.79
| Facility | | $588.84 | $1,659.59 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,905.46
| Professional | | $575.44 | $891.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,238.72 / $7,079.46
| Facility | | $676.08 | $2,238.72 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,318.26
| Professional | | $512.86 | $741.31 | $1,318.26 |