- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,090.30 / $9,332.54
| Facility | | $758.58 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $851.14 / $2,570.40
| Professional | | $371.54 | $851.14 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,248.07 / $12,022.64
| Facility | | $1,819.70 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $933.25 / $4,466.84
| Professional | | $398.11 | $933.25 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $954.99 / $4,570.88
| Facility | | $478.63 | $954.99 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $870.96 / $3,548.13
| Professional | | $389.05 | $870.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,772.37
| Facility | | $1,047.13 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $831.76 / $3,467.37
| Professional | | $354.81 | $831.76 | $3,467.37 |