- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,897.79 / $10,471.29
| Facility | | $912.01 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,122.02
| Professional | | $478.63 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,047.13 / $1,202.26
| Professional | | $489.78 | $1,047.13 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,318.26
| Professional | | $549.54 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $912.01
| Professional | | $794.33 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,548.82
| Professional | | $512.86 | $812.83 | $1,548.82 |