- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,365.16 / $10,964.78
| Facility | | $912.01 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $575.44 / $1,318.26
| Professional | | $467.74 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,244.36 / $14,791.08
| Facility | | $2,818.38 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $707.95 / $1,348.96
| Professional | | $446.68 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,659.59 / $4,168.69
| Facility | | $812.83 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,698.24
| Professional | | $489.78 | $794.33 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,202.26
| Professional | | $446.68 | $645.65 | $1,202.26 |