- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,365.16 / $10,964.78
| Facility | | $954.99 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $1,513.56
| Professional | | $537.03 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $724.44 / $1,445.44
| Professional | | $416.87 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $5,370.32
| Facility | | $1,047.13 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,905.46
| Professional | | $588.84 | $870.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,318.26
| Professional | | $489.78 | $691.83 | $1,318.26 |