- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,162.28 / $9,332.54
| Facility | | $501.19 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $1,174.90
| Professional | | $309.03 | $489.78 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,754.40 / $13,489.63
| Facility | | $1,905.46 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $851.14
| Professional | | $263.03 | $457.09 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,174.90 / $3,630.78
| Facility | | $457.09 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $1,230.27
| Professional | | $338.84 | $562.34 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,772.37
| Facility | | $1,513.56 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $870.96
| Professional | | $295.12 | $457.09 | $870.96 |