- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $5,495.41 / $15,488.17
| Facility | | $851.14 | $5,495.41 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $954.99 / $2,454.71
| Professional | | $288.40 | $954.99 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $20,892.96
| Facility | | $3,548.13 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,318.26 / $3,090.30
| Professional | | $309.03 | $1,318.26 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,073.80 / $12,022.64
| Facility | | $323.59 | $4,073.80 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,096.48 / $3,548.13
| Professional | | $346.74 | $1,096.48 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $18,620.87
| Facility | | $2,951.21 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,230.27 / $2,818.38
| Professional | | $309.03 | $1,230.27 | $2,818.38 |