- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,715.35 / $10,232.93
| Facility | | $676.08 | $3,715.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,174.90
| Professional | | $416.87 | $588.84 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,309.57 / $12,302.69
| Facility | | $2,398.83 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,230.27
| Professional | | $416.87 | $660.69 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,862.09 / $5,248.07
| Facility | | $724.44 | $1,862.09 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $1,479.11
| Professional | | $426.58 | $676.08 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,096.48
| Professional | | $380.19 | $575.44 | $1,096.48 |