- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,981.07 / $10,715.19
| Facility | | $741.31 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $1,071.52
| Professional | | $380.19 | $467.74 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,888.44 / $13,489.63
| Facility | | $2,089.30 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $1,047.13
| Professional | | $389.05 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,288.25 / $3,090.30
| Facility | | $630.96 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $630.96 / $1,348.96
| Professional | | $416.87 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $933.25
| Professional | | $354.81 | $512.86 | $933.25 |