- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,897.79 / $5,623.41
| Facility | | $831.76 | $4,897.79 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $1,737.80
| Professional | | $489.78 | $831.76 | $1,737.80 |
- 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
- $407.38 / $478.63 / $724.44
| Professional | | $407.38 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $9,120.11 / $43,651.58
| Facility | | $562.34 | $9,120.11 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $2,818.38
| Professional | | $501.19 | $588.84 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,238.72 / $7,413.10
| Facility | | $933.25 | $2,238.72 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $741.31 / $1,621.81
| Professional | | $208.93 | $741.31 | $1,621.81 |