- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,365.16 / $10,964.78
| Facility | | $977.24 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $1,348.96
| Professional | | $524.81 | $660.69 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,348.96
| Professional | | $489.78 | $691.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,778.28 / $4,168.69
| Facility | | $851.14 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $812.83 / $1,819.70
| Professional | | $478.63 | $812.83 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,884.03 / $6,456.54
| Facility | | $912.01 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $1,174.90
| Professional | | $457.09 | $616.60 | $1,174.90 |