- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,388.44 / $9,332.54
| Facility | | $776.25 | $3,388.44 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $707.95 / $1,318.26
| Professional | | $478.63 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,570.88 / $10,232.93
| Facility | | $2,089.30 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $1,318.26
| Professional | | $436.52 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,621.81 / $5,248.07
| Facility | | $354.81 | $1,621.81 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $831.76 / $1,905.46
| Professional | | $478.63 | $831.76 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,884.03 / $6,456.54
| Facility | | $912.01 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,258.93
| Professional | | $436.52 | $676.08 | $1,258.93 |