- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,548.13 / $9,120.11
| Facility | | $630.96 | $3,548.13 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $724.44 / $2,041.74
| Professional | | $194.98 | $724.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $13,489.63
| Facility | | $2,630.27 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,047.13 / $2,570.40
| Professional | | $229.09 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,698.24 / $4,466.84
| Facility | | $323.59 | $1,698.24 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $870.96 / $2,630.27
| Professional | | $234.42 | $870.96 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $12,022.64
| Facility | | $1,348.96 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $812.83 / $2,290.87
| Professional | | $199.53 | $812.83 | $2,290.87 |