- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.35 / $2,145.78 / $7,119.04
| Facility | | $601.35 | $2,145.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.65 / $745.51 / $1,016.55
| Professional | | $497.65 | $745.51 | $1,016.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $2,971.00 / $4,707.00
| Facility | | $1,529.00 | $2,971.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.01 / $744.02 / $1,301.65
| Professional | | $491.01 | $744.02 | $1,301.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.42 / $451.00 / $555.00
| Facility | | $397.42 | $451.00 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.70 / $807.51 / $1,423.00
| Professional | | $478.70 | $807.51 | $1,423.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.92 / $1,813.00 / $3,847.00
| Facility | | $682.92 | $1,813.00 | $3,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.47 / $787.54 / $1,342.08
| Professional | | $506.47 | $787.54 | $1,342.08 |