- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $4,570.88 / $11,220.18
| Facility | | $741.31 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $1,047.13
| Professional | | $416.87 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $14,791.08
| Facility | | $2,630.27 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,174.90
| Professional | | $407.38 | $588.84 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,258.93 / $4,073.80
| Facility | | $549.54 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $1,584.89
| Professional | | $416.87 | $676.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $1,023.29
| Professional | | $389.05 | $549.54 | $1,023.29 |