- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,570.88 / $11,481.54
| Facility | | $812.83 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $1,071.52
| Professional | | $457.09 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $13,489.63 / $28,840.32
| Facility | | $4,786.30 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $1,513.56
| Professional | | $512.86 | $794.33 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,412.54 / $16,595.87
| Facility | | $398.11 | $1,412.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $912.01 / $1,621.81
| Professional | | $524.81 | $912.01 | $1,621.81 |
- 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 / $851.14 / $1,445.44
| Professional | | $549.54 | $851.14 | $1,445.44 |