- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,365.16 / $10,715.19
| Facility | | $912.01 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $1,148.15
| Professional | | $436.52 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $17,782.79
| Facility | | $3,311.31 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,230.27
| Professional | | $446.68 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $3,801.89
| Facility | | $323.59 | $1,348.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,513.56
| Professional | | $489.78 | $758.58 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,585.78 / $17,782.79
| Facility | | $2,511.89 | $7,585.78 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $1,122.02
| Professional | | $426.58 | $602.56 | $1,122.02 |