- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,884.03 / $8,511.38
| Facility | | $588.84 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,202.26
| Professional | | $331.13 | $562.34 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $13,489.63
| Facility | | $1,862.09 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,288.25
| Professional | | $416.87 | $660.69 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,659.59 / $5,623.41
| Facility | | $630.96 | $1,659.59 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $724.44 / $1,548.82
| Professional | | $416.87 | $724.44 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,187.76 / $5,248.07
| Facility | | $676.08 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $630.96 / $1,202.26
| Professional | | $380.19 | $630.96 | $1,202.26 |