- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,466.84 / $10,964.78
| Facility | | $977.24 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $1,548.82
| Professional | | $537.03 | $676.08 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $11,220.18
| Facility | | $2,290.87 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $1,513.56
| Professional | | $512.86 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,778.28 / $4,265.80
| Facility | | $758.58 | $1,778.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $1,949.84
| Professional | | $562.34 | $891.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,348.96
| Professional | | $512.86 | $741.31 | $1,348.96 |