- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $5,128.61 / $13,182.57
| Facility | | $891.25 | $5,128.61 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $741.31 / $1,445.44
| Professional | | $275.42 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,918.31 / $18,620.87
| Facility | | $2,818.38 | $6,918.31 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $851.14 / $2,344.23
| Professional | | $338.84 | $851.14 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,754.23 / $6,606.93
| Facility | | $512.86 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $954.99 / $2,454.71
| Professional | | $354.81 | $954.99 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $22,908.68
| Facility | | $3,019.95 | $8,912.51 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $831.76 / $1,995.26
| Professional | | $302.00 | $831.76 | $1,995.26 |