- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,570.88 / $11,481.54
| Facility | | $933.25 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $1,819.70
| Professional | | $602.56 | $776.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,471.29 / $21,877.62
| Facility | | $3,890.45 | $10,471.29 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $1,778.28
| Professional | | $588.84 | $954.99 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,412.54 / $5,495.41
| Facility | | $398.11 | $1,412.54 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,047.13 / $2,398.83
| Professional | | $676.08 | $1,047.13 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,659.59
| Professional | | $588.84 | $851.14 | $1,659.59 |