- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,715.35 / $9,772.37
| Facility | | $933.25 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,412.54
| Professional | | $501.19 | $602.56 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,606.93 / $13,803.84
| Facility | | $2,630.27 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,412.54
| Professional | | $489.78 | $758.58 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,202.26 / $4,265.80
| Facility | | $501.19 | $1,202.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $1,819.70
| Professional | | $537.03 | $831.76 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,168.69 / $9,549.93
| Facility | | $1,479.11 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,258.93
| Professional | | $467.74 | $660.69 | $1,258.93 |