- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,897.79 / $8,511.38
| Facility | | $776.25 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $794.33
| Professional | | $275.42 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $616.60 / $1,047.13
| Professional | | $371.54 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,096.48
| Professional | | $371.54 | $676.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $794.33
| Professional | | $776.25 | $776.25 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $954.99
| Professional | | $288.40 | $501.19 | $954.99 |