- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,467.37 / $10,715.19
| Facility | | $691.83 | $3,467.37 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,737.80
| Professional | | $478.63 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,897.79 / $10,715.19
| Facility | | $2,089.30 | $4,897.79 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,412.54
| Professional | | $512.86 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $912.01 / $5,011.87
| Facility | | $141.25 | $912.01 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $1,862.09
| Professional | | $562.34 | $912.01 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,388.44
| Facility | | $204.17 | $1,071.52 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,380.38
| Professional | | $478.63 | $741.31 | $1,380.38 |