- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,691.53 / $8,511.38
| Facility | | $512.86 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $1,122.02
| Professional | | $302.00 | $407.38 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $1,023.29
| Professional | | $354.81 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $870.96 / $3,311.31
| Facility | | $281.84 | $870.96 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,174.90
| Professional | | $346.74 | $575.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $3,548.13
| Facility | | $316.23 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $891.25
| Professional | | $309.03 | $478.63 | $891.25 |