- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $7,079.46 / $14,125.38
| Facility | | $501.19 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $371.54 / $758.58
| Professional | | $151.36 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,174.90
| Professional | | $562.34 | $562.34 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $436.52 / $1,621.81
| Facility | | $186.21 | $436.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $912.01 / $2,344.23
| Professional | | $363.08 | $912.01 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,047.13 / $2,089.30
| Professional | | $645.65 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $776.25 / $2,290.87
| Facility | | $295.12 | $776.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $223.87 / $1,174.90
| Professional | | $60.26 | $223.87 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $912.01 / $1,479.11
| Professional | | $407.38 | $912.01 | $1,479.11 |