- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $9,772.37
| Facility | | $1,096.48 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $295.12 / $6,606.93
| Professional | | $52.48 | $295.12 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $12,302.69
| Facility | | $1,819.70 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $128.82 / $3,715.35
| Professional | | $57.54 | $128.82 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $10,471.29 / $28,840.32
| Facility | | $97.72 | $10,471.29 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $3,548.13 / $4,466.84
| Professional | | $61.66 | $3,548.13 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,318.26 / $4,786.30
| Facility | | $316.23 | $1,318.26 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $1,348.96 / $3,630.78
| Professional | | $52.48 | $1,348.96 | $3,630.78 |