- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $5,888.44 / $10,964.78
| Facility | | $758.58 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $501.19 / $1,047.13
| Professional | | $389.05 | $501.19 | $1,047.13 |
- 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
- $416.87 / $794.33 / $1,023.29
| Professional | | $416.87 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $1,412.54
| Professional | | $354.81 | $588.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $758.58
| Professional | | $338.84 | $575.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $1,148.15
| Professional | | $371.54 | $501.19 | $1,148.15 |