- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,884.03 / $8,511.38
| Facility | | $630.96 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $1,479.11
| Professional | | $436.52 | $588.84 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,230.27
| Professional | | $446.68 | $645.65 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,659.59 / $4,677.35
| Facility | | $588.84 | $1,659.59 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,621.81
| Professional | | $478.63 | $741.31 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,456.54
| Facility | | $1,023.29 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $630.96 / $1,174.90
| Professional | | $426.58 | $630.96 | $1,174.90 |