- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,981.07 / $6,760.83
| Facility | | $467.74 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $616.60
| Professional | | $363.08 | $489.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $758.58 / $1,230.27
| Professional | | $616.60 | $758.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $575.44 / $870.96
| Professional | | $151.36 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $5,370.32 / $18,197.01
| Facility | | $549.54 | $5,370.32 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $831.76 / $3,715.35
| Professional | | $524.81 | $831.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $758.58 / $1,230.27
| Professional | | $616.60 | $758.58 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,413.10 / $19,498.45
| Facility | | $4,365.16 | $7,413.10 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,445.44
| Professional | | $501.19 | $776.25 | $1,445.44 |