- 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 / $645.65 / $1,412.54
| Professional | | $537.03 | $645.65 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,918.31 / $20,417.38
| Facility | | $3,162.28 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,479.11
| Professional | | $512.86 | $741.31 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,819.70 / $5,370.32
| Facility | | $707.95 | $1,819.70 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,949.84
| Professional | | $588.84 | $870.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,318.26
| Professional | | $489.78 | $691.83 | $1,318.26 |