- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $9,772.37
| Facility | | $977.24 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,445.44
| Professional | | $562.34 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,760.83 / $20,417.38
| Facility | | $2,511.89 | $6,760.83 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,548.82
| Professional | | $562.34 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,949.84 / $5,495.41
| Facility | | $1,096.48 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $1,995.26
| Professional | | $630.96 | $933.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,677.35 / $11,220.18
| Facility | | $1,513.56 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,380.38
| Professional | | $524.81 | $741.31 | $1,380.38 |