- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,897.79 / $10,471.29
| Facility | | $870.96 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $1,513.56
| Professional | | $457.09 | $588.84 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,748.98 / $13,803.84
| Facility | | $2,754.23 | $11,748.98 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,071.52 / $1,230.27
| Professional | | $457.09 | $1,071.52 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,258.93
| Professional | | $537.03 | $812.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $870.96
| Professional | | $851.14 | $851.14 | $870.96 |
- 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
- $501.19 / $776.25 / $1,479.11
| Professional | | $501.19 | $776.25 | $1,479.11 |