- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,897.79 / $7,413.10
| Facility | | $776.25 | $4,897.79 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $954.99
| Professional | | $436.52 | $537.03 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,454.71 / $4,786.30
| Facility | | $1,071.52 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $1,071.52
| Professional | | $467.74 | $588.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $1,122.02
| Professional | | $416.87 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,023.29
| Professional | | $501.19 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,090.30 / $5,370.32
| Facility | | $1,047.13 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,258.93
| Professional | | $467.74 | $676.08 | $1,258.93 |