- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,890.45 / $10,471.29
| Facility | | $870.96 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $933.25
| Professional | | $416.87 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,218.10
| Facility | | $3,235.94 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $1,047.13
| Professional | | $389.05 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,023.29 / $3,890.45
| Facility | | $489.78 | $1,023.29 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $616.60 / $1,318.26
| Professional | | $380.19 | $616.60 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,128.61 / $12,589.25
| Facility | | $1,348.96 | $5,128.61 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $954.99
| Professional | | $380.19 | $524.81 | $954.99 |