- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,715.35 / $9,772.37
| Facility | | $851.14 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $1,318.26
| Professional | | $446.68 | $562.34 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,079.46 / $14,791.08
| Facility | | $2,454.71 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,230.27
| Professional | | $407.38 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $3,630.78
| Facility | | $776.25 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,513.56
| Professional | | $467.74 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $1,148.15
| Professional | | $436.52 | $630.96 | $1,148.15 |