- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,570.88 / $11,481.54
| Facility | | $933.25 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $676.08 / $1,513.56
| Professional | | $602.56 | $676.08 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,549.93 / $17,782.79
| Facility | | $3,630.78 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,659.59
| Professional | | $602.56 | $891.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,995.26 / $5,623.41
| Facility | | $323.59 | $1,995.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $2,187.76
| Professional | | $660.69 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $1,548.82
| Professional | | $588.84 | $831.76 | $1,548.82 |