- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,890.45 / $10,715.19
| Facility | | $707.95 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,230.27
| Professional | | $436.52 | $524.81 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,248.07 / $10,964.78
| Facility | | $1,905.46 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $1,174.90
| Professional | | $426.58 | $602.56 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,862.09 / $5,248.07
| Facility | | $851.14 | $1,862.09 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,548.82
| Professional | | $457.09 | $691.83 | $1,548.82 |
- 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
- $407.38 / $588.84 / $1,096.48
| Professional | | $407.38 | $588.84 | $1,096.48 |