- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,890.45 / $10,471.29
| Facility | | $851.14 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $741.31 / $1,584.89
| Professional | | $562.34 | $741.31 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,025.60 / $12,302.69
| Facility | | $2,089.30 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,548.82
| Professional | | $602.56 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,862.09 / $5,754.40
| Facility | | $812.83 | $1,862.09 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $954.99 / $2,041.74
| Professional | | $616.60 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,513.56
| Professional | | $562.34 | $812.83 | $1,513.56 |