- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,981.07 / $10,715.19
| Facility | | $602.56 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $891.25
| Professional | | $295.12 | $436.52 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,890.45 / $9,549.93
| Facility | | $1,819.70 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $954.99
| Professional | | $316.23 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,318.26 / $3,715.35
| Facility | | $398.11 | $1,318.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $1,202.26
| Professional | | $331.13 | $549.54 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $891.25
| Professional | | $295.12 | $467.74 | $891.25 |