- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,890.45 / $10,715.19
| Facility | | $794.33 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,318.26
| Professional | | $501.19 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,585.78 / $16,595.87
| Facility | | $2,884.03 | $7,585.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,348.96
| Professional | | $478.63 | $676.08 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,862.09 / $4,786.30
| Facility | | $676.08 | $1,862.09 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $870.96 / $1,862.09
| Professional | | $524.81 | $870.96 | $1,862.09 |
- 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
- $478.63 / $724.44 / $1,348.96
| Professional | | $478.63 | $724.44 | $1,348.96 |