- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,951.21 / $10,715.19
| Facility | | $524.81 | $2,951.21 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $380.19 / $1,023.29
| Professional | | $131.83 | $380.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,232.93 / $18,620.87
| Facility | | $4,897.79 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $616.60 / $1,412.54
| Professional | | $134.90 | $616.60 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,089.30 / $15,135.61
| Facility | | $245.47 | $2,089.30 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $524.81 / $1,621.81
| Professional | | $154.88 | $524.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,801.89
| Facility | | $295.12 | $1,202.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $562.34 / $1,318.26
| Professional | | $141.25 | $562.34 | $1,318.26 |