- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,897.79 / $10,471.29
| Facility | | $977.24 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $977.24
| Professional | | $446.68 | $537.03 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $12,022.64
| Facility | | $3,630.78 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $912.01 / $1,258.93
| Professional | | $436.52 | $912.01 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $3,548.13
| Facility | | $1,000.00 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $1,513.56
| Professional | | $501.19 | $741.31 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $812.83 / $1,047.13
| Professional | | $616.60 | $812.83 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $7,762.47 / $11,481.54
| Facility | | $1,047.13 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $630.96 / $1,445.44
| Professional | | $446.68 | $630.96 | $1,445.44 |