- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,388.44 / $9,549.93
| Facility | | $794.33 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,819.70
| Professional | | $575.44 | $776.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $12,302.69
| Facility | | $2,041.74 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $1,584.89
| Professional | | $616.60 | $851.14 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,862.09 / $5,888.44
| Facility | | $794.33 | $1,862.09 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $954.99 / $2,137.96
| Professional | | $616.60 | $954.99 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,513.56
| Professional | | $562.34 | $812.83 | $1,513.56 |