- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,365.16 / $10,715.19
| Facility | | $977.24 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $1,380.38
| Professional | | $537.03 | $616.60 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $1,513.56
| Professional | | $537.03 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,819.70 / $4,365.16
| Facility | | $912.01 | $1,819.70 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,905.46
| Professional | | $602.56 | $933.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $1,348.96
| Professional | | $501.19 | $741.31 | $1,348.96 |