- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,365.16 / $10,471.29
| Facility | | $794.33 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,230.27 / $3,388.44
| Professional | | $354.81 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $16,218.10
| Facility | | $3,311.31 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,348.96 / $3,548.13
| Professional | | $371.54 | $1,348.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $3,235.94 / $10,964.78
| Facility | | $371.54 | $3,235.94 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,318.26 / $3,981.07
| Professional | | $416.87 | $1,318.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,302.69
| Facility | | $1,905.46 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,318.26 / $3,090.30
| Professional | | $371.54 | $1,318.26 | $3,090.30 |