- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,715.35 / $10,232.93
| Facility | | $660.69 | $3,715.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $851.14 / $2,238.72
| Professional | | $331.13 | $851.14 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,248.07 / $11,220.18
| Facility | | $1,905.46 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $1,202.26
| Professional | | $295.12 | $549.54 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,862.09 / $7,585.78
| Facility | | $478.63 | $1,862.09 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $933.25 / $2,290.87
| Professional | | $363.08 | $933.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,918.31
| Facility | | $1,023.29 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $741.31 / $1,659.59
| Professional | | $316.23 | $741.31 | $1,659.59 |