- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,365.16 / $10,964.78
| Facility | | $933.25 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $1,047.13
| Professional | | $457.09 | $537.03 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,585.78 / $16,218.10
| Facility | | $2,818.38 | $7,585.78 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $1,071.52
| Professional | | $426.58 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,318.26 / $4,365.16
| Facility | | $575.44 | $1,318.26 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,412.54
| Professional | | $446.68 | $676.08 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,456.54 / $15,848.93
| Facility | | $1,778.28 | $6,456.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,023.29
| Professional | | $407.38 | $575.44 | $1,023.29 |