- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,235.94 / $8,912.51
| Facility | | $588.84 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $588.84 / $1,412.54
| Professional | | $173.78 | $588.84 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,011.87 / $12,022.64
| Facility | | $1,698.24 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $616.60 / $1,737.80
| Professional | | $208.93 | $616.60 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,344.23 / $5,623.41
| Facility | | $295.12 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $645.65 / $1,949.84
| Professional | | $199.53 | $645.65 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $562.34 / $1,548.82
| Professional | | $177.83 | $562.34 | $1,548.82 |