- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,311.31 / $10,471.29
| Facility | | $933.25 | $3,311.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,659.59
| Professional | | $616.60 | $724.44 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,918.31 / $15,135.61
| Facility | | $3,235.94 | $6,918.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,698.24
| Professional | | $537.03 | $776.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,630.27 / $12,302.69
| Facility | | $1,148.15 | $2,630.27 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $2,454.71
| Professional | | $691.83 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,317.64 / $17,782.79
| Facility | | $2,951.21 | $8,317.64 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,659.59
| Professional | | $616.60 | $912.01 | $1,659.59 |