- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $10,471.29
| Facility | | $933.25 | $3,467.37 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $977.24
| Professional | | $524.81 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,748.98 / $20,892.96
| Facility | | $5,011.87 | $11,748.98 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $660.69 / $1,318.26
| Professional | | $213.80 | $660.69 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,023.29 / $15,488.17
| Facility | | $602.56 | $1,023.29 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,412.54
| Professional | | $549.54 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,888.44 / $13,803.84
| Facility | | $1,778.28 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $758.58
| Professional | | $245.47 | $380.19 | $758.58 |