- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,630.78 / $9,772.37
| Facility | | $524.81 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $2,754.23 / $6,760.83
| Professional | | $165.96 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,128.61 / $14,125.38
| Facility | | $2,238.72 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $2,691.53 / $7,244.36
| Professional | | $169.82 | $2,691.53 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $8,912.51 / $21,877.62
| Facility | | $281.84 | $8,912.51 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $676.08 / $7,585.78
| Professional | | $190.55 | $676.08 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $18,197.01
| Facility | | $2,951.21 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $2,344.23 / $6,165.95
| Professional | | $162.18 | $2,344.23 | $6,165.95 |