- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,466.84 / $11,220.18
| Facility | | $851.14 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $977.24
| Professional | | $380.19 | $467.74 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,456.54 / $14,125.38
| Facility | | $2,818.38 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,148.15
| Professional | | $331.13 | $562.34 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,041.74 / $30,199.52
| Facility | | $676.08 | $2,041.74 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $645.65 / $1,348.96
| Professional | | $407.38 | $645.65 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,589.25
| Facility | | $1,905.46 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $977.24
| Professional | | $371.54 | $549.54 | $977.24 |