- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,466.84 / $10,964.78
| Facility | | $977.24 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $1,318.26
| Professional | | $512.86 | $602.56 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,412.54
| Professional | | $512.86 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $5,011.87
| Facility | | $977.24 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,819.70
| Professional | | $562.34 | $831.76 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,258.93
| Professional | | $467.74 | $660.69 | $1,258.93 |