- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,365.16 / $10,715.19
| Facility | | $870.96 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,071.52
| Professional | | $436.52 | $524.81 | $1,071.52 |
- 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
- $380.19 / $549.54 / $1,023.29
| Professional | | $380.19 | $549.54 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,230.27 / $3,019.95
| Facility | | $562.34 | $1,230.27 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,380.38
| Professional | | $407.38 | $630.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $977.24
| Professional | | $380.19 | $524.81 | $977.24 |