- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,370.32 / $7,413.10
| Facility | | $933.25 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $691.83 / $1,288.25
| Professional | | $524.81 | $691.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $4,786.30
| Facility | | $1,047.13 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $933.25 / $1,288.25
| Professional | | $562.34 | $933.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,905.46
| Facility | | $912.01 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $954.99 / $1,548.82
| Professional | | $616.60 | $954.99 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $4,466.84
| Professional | | $575.44 | $870.96 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,412.54
| Professional | | $537.03 | $812.83 | $1,412.54 |