- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,365.16 / $10,964.78
| Facility | | $831.76 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $1,023.29
| Professional | | $346.74 | $407.38 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $933.25
| Professional | | $338.84 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $3,311.31
| Facility | | $660.69 | $1,318.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,202.26
| Professional | | $380.19 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $851.14
| Professional | | $323.59 | $457.09 | $851.14 |