- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $9,772.37
| Facility | | $933.25 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $758.58
| Professional | | $416.87 | $575.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $12,302.69
| Facility | | $2,137.96 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $60.26 / $630.96
| Professional | | $38.02 | $60.26 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $19,952.62
| Facility | | $933.25 | $933.25 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,570.40 / $2,570.40
| Professional | | $812.83 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,162.28 / $10,232.93
| Facility | | $831.76 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,258.93
| Professional | | $512.86 | $707.95 | $1,258.93 |