- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $5,370.32 / $10,715.19
| Facility | | $794.33 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $478.63 / $1,513.56
| Professional | | $281.84 | $478.63 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $17,782.79
| Facility | | $2,951.21 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $645.65
| Professional | | $251.19 | $354.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $5,754.40
| Facility | | $489.78 | $933.25 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $831.76
| Professional | | $275.42 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,265.80 / $10,471.29
| Facility | | $1,047.13 | $4,265.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $602.56
| Professional | | $239.88 | $331.13 | $602.56 |