- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,073.80 / $10,715.19
| Facility | | $831.76 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $831.76 / $1,445.44
| Professional | | $346.74 | $831.76 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,888.44 / $13,803.84
| Facility | | $2,137.96 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $912.01 / $1,995.26
| Professional | | $371.54 | $912.01 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,454.71 / $12,302.69
| Facility | | $562.34 | $2,454.71 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $2,238.72
| Professional | | $380.19 | $912.01 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $831.76 / $1,778.28
| Professional | | $346.74 | $831.76 | $1,778.28 |