- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,388.44 / $9,120.11
| Facility | | $630.96 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $1,047.13
| Professional | | $323.59 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $933.25
| Professional | | $234.42 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,659.59 / $4,466.84
| Facility | | $602.56 | $1,659.59 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,445.44
| Professional | | $354.81 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $1,023.29
| Professional | | $302.00 | $512.86 | $1,023.29 |