- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,715.35 / $9,772.37
| Facility | | $851.14 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $1,230.27
| Professional | | $416.87 | $489.78 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,570.88 / $11,220.18
| Facility | | $2,041.74 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,096.48
| Professional | | $407.38 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $4,365.16
| Facility | | $851.14 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,513.56
| Professional | | $446.68 | $676.08 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $10,964.78
| Facility | | $1,548.82 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $1,047.13
| Professional | | $407.38 | $562.34 | $1,047.13 |