- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,128.61 / $12,022.64
| Facility | | $977.24 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $776.25
| Professional | | $281.84 | $354.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $20,892.96
| Facility | | $3,548.13 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $794.33
| Professional | | $281.84 | $436.52 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,122.02 / $2,630.27
| Facility | | $524.81 | $1,122.02 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $1,023.29
| Professional | | $316.23 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $14,125.38
| Facility | | $1,995.26 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $724.44
| Professional | | $269.15 | $389.05 | $724.44 |