- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,897.79 / $11,481.54
| Facility | | $933.25 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $263.03 / $1,621.81
| Professional | | $213.80 | $263.03 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,413.10 / $15,848.93
| Facility | | $2,818.38 | $7,413.10 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $2,238.72
| Professional | | $208.93 | $380.19 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,737.80
| Facility | | $323.59 | $575.44 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $831.76
| Professional | | $234.42 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,951.21 / $10,232.93
| Facility | | $512.86 | $2,951.21 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $263.03 / $512.86
| Professional | | $177.83 | $263.03 | $512.86 |