- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $3,235.94 / $8,912.51
| Facility | | $371.54 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $660.69
| Professional | | $204.17 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $645.65
| Professional | | $218.78 | $331.13 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,202.26 / $2,951.21
| Facility | | $398.11 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $831.76
| Professional | | $223.87 | $371.54 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $602.56
| Professional | | $204.17 | $316.23 | $602.56 |