- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,981.07 / $10,232.93
| Facility | | $549.54 | $3,981.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $549.54 / $1,412.54
| Professional | | $346.74 | $549.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,025.60 / $12,302.69
| Facility | | $1,949.84 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $954.99
| Professional | | $338.84 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,023.29 / $2,691.53
| Facility | | $512.86 | $1,023.29 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,202.26
| Professional | | $354.81 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,890.45 / $9,549.93
| Facility | | $1,023.29 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $912.01
| Professional | | $316.23 | $501.19 | $912.01 |