- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $11,748.98
| Facility | | $851.14 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $1,380.38
| Professional | | $537.03 | $676.08 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,302.69 / $33,113.11
| Facility | | $4,466.84 | $12,302.69 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,445.44
| Professional | | $446.68 | $645.65 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,570.88 / $18,620.87
| Facility | | $977.24 | $4,570.88 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,905.46
| Professional | | $602.56 | $933.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $794.33 / $1,412.54
| Professional | | $549.54 | $794.33 | $1,412.54 |