- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,801.89 / $10,232.93
| Facility | | $630.96 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $524.81 / $1,122.02
| Professional | | $109.65 | $524.81 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $9,549.93
| Facility | | $1,548.82 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $645.65 / $1,445.44
| Professional | | $131.83 | $645.65 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,905.46 / $4,786.30
| Facility | | $213.80 | $1,905.46 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $588.84 / $1,778.28
| Professional | | $154.88 | $588.84 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,949.84 / $4,786.30
| Facility | | $588.84 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $537.03 / $1,445.44
| Professional | | $128.82 | $537.03 | $1,445.44 |