- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.16 / $660.06 / $1,742.00
| Facility | | $135.16 | $660.06 | $1,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.68 / $565.69 / $948.95
| Professional | | $113.68 | $565.69 | $948.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.12 / $682.12 / $819.22
| Facility | | $682.12 | $682.12 | $819.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.24 / $473.47 / $1,716.37
| Professional | | $147.24 | $473.47 | $1,716.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.07 / $1,101.41 / $1,432.13
| Professional | | $743.07 | $1,101.41 | $1,432.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.77 / $806.41 / $1,637.78
| Facility | | $650.77 | $806.41 | $1,637.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.07 / $1,013.90 / $1,683.48
| Professional | | $737.07 | $1,013.90 | $1,683.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.18 / $933.21 / $1,460.66
| Professional | | $510.18 | $933.21 | $1,460.66 |