- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,570.88 / $11,220.18
| Facility | | $812.83 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,479.11
| Professional | | $549.54 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,943.28 / $14,791.08
| Facility | | $2,818.38 | $7,943.28 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $794.33 / $1,445.44
| Professional | | $524.81 | $794.33 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,513.56 / $4,786.30
| Facility | | $489.78 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $1,949.84
| Professional | | $562.34 | $891.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,760.83 / $15,135.61
| Facility | | $1,949.84 | $6,760.83 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,348.96
| Professional | | $512.86 | $724.44 | $1,348.96 |