- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,388.44 / $9,120.11
| Facility | | $645.65 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,023.29
| Professional | | $354.81 | $512.86 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $11,220.18
| Facility | | $1,819.70 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,122.02
| Professional | | $354.81 | $575.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,737.80 / $4,786.30
| Facility | | $616.60 | $1,737.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,348.96
| Professional | | $371.54 | $588.84 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,918.31
| Facility | | $1,023.29 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $954.99
| Professional | | $323.59 | $501.19 | $954.99 |