- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,818.38 / $8,912.51
| Facility | | $562.34 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $676.08 / $1,288.25
| Professional | | $158.49 | $676.08 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,495.41 / $12,022.64
| Facility | | $2,238.72 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $660.69 / $1,548.82
| Professional | | $190.55 | $660.69 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,290.87 / $5,623.41
| Facility | | $275.42 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $660.69 / $1,862.09
| Professional | | $186.21 | $660.69 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,168.69 / $9,549.93
| Facility | | $1,513.56 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $588.84 / $1,380.38
| Professional | | $165.96 | $588.84 | $1,380.38 |