- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,365.16 / $11,220.18
| Facility | | $660.69 | $4,365.16 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $1,071.52
| Professional | | $389.05 | $549.54 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,912.51 / $17,782.79
| Facility | | $3,235.94 | $8,912.51 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $575.44 / $1,096.48
| Professional | | $398.11 | $575.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,949.84 / $4,570.88
| Facility | | $660.69 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $707.95 / $1,479.11
| Professional | | $426.58 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,148.15
| Professional | | $407.38 | $616.60 | $1,148.15 |