- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,630.78 / $7,413.10
| Facility | | $660.69 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $851.14
| Professional | | $346.74 | $446.68 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,884.03 / $6,918.31
| Facility | | $794.33 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $977.24
| Professional | | $389.05 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,000.00
| Professional | | $426.58 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $870.96
| Professional | | $316.23 | $501.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $933.25
| Professional | | $371.54 | $537.03 | $933.25 |