- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $8,912.51
| Facility | | $794.33 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,148.15
| Professional | | $436.52 | $524.81 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $13,803.84
| Facility | | $1,621.81 | $4,897.79 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,174.90
| Professional | | $407.38 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $3,801.89
| Facility | | $707.95 | $1,318.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,513.56
| Professional | | $457.09 | $724.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,162.28 / $7,413.10
| Facility | | $1,023.29 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,071.52
| Professional | | $407.38 | $588.84 | $1,071.52 |