- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,570.88 / $11,481.54
| Facility | | $933.25 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,548.82
| Professional | | $630.96 | $741.31 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,471.29 / $19,498.45
| Facility | | $3,467.37 | $10,471.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,778.28
| Professional | | $660.69 | $977.24 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,513.56 / $5,248.07
| Facility | | $398.11 | $1,513.56 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $2,238.72
| Professional | | $707.95 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,584.89
| Professional | | $602.56 | $870.96 | $1,584.89 |