- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,897.79 / $5,623.41
| Facility | | $851.14 | $4,897.79 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $851.14 / $1,288.25
| Professional | | $223.87 | $851.14 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $30,199.52 / $43,651.58
| Facility | | $12,589.25 | $30,199.52 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $776.25
| Professional | | $354.81 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $27,542.29 / $43,651.58
| Facility | | $1,737.80 | $27,542.29 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $7,943.28
| Professional | | $537.03 | $630.96 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,623.41 / $12,022.64
| Facility | | $1,412.54 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $3,981.07
| Professional | | $1,047.13 | $1,862.09 | $3,981.07 |