- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,388.44 / $9,120.11
| Facility | | $616.60 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $1,023.29
| Professional | | $346.74 | $501.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $11,220.18
| Facility | | $1,819.70 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,071.52
| Professional | | $354.81 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,659.59 / $4,466.84
| Facility | | $602.56 | $1,659.59 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $1,288.25
| Professional | | $363.08 | $588.84 | $1,288.25 |
- 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
- $323.59 / $501.19 / $933.25
| Professional | | $323.59 | $501.19 | $933.25 |