- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $5,128.61 / $11,748.98
| Facility | | $524.81 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $1,318.26
| Professional | | $323.59 | $436.52 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,456.54 / $12,589.25
| Facility | | $2,630.27 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,047.13
| Professional | | $346.74 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,513.56 / $3,548.13
| Facility | | $630.96 | $1,513.56 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $1,174.90
| Professional | | $371.54 | $562.34 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,232.93
| Facility | | $1,584.89 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $870.96
| Professional | | $338.84 | $467.74 | $870.96 |