- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,884.03 / $9,120.11
| Facility | | $588.84 | $2,884.03 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $1,047.13 / $2,041.74
| Professional | | $251.19 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,888.44 / $13,489.63
| Facility | | $3,311.31 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,288.25 / $3,311.31
| Professional | | $269.15 | $1,288.25 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,235.94 / $8,709.64
| Facility | | $245.47 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $933.25 / $3,388.44
| Professional | | $288.40 | $933.25 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $1,071.52 / $2,754.23
| Professional | | $257.04 | $1,071.52 | $2,754.23 |