- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.93 / $3,196.47 / $8,006.50
| Facility | | $435.93 | $3,196.47 | $8,006.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.05 / $406.25 / $739.28
| Professional | | $277.05 | $406.25 | $739.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,160.00 / $10,517.23
| Facility | | $3,302.10 | $5,160.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.61 / $461.08 / $739.14
| Professional | | $317.61 | $461.08 | $739.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.70 / $1,620.06 / $2,247.83
| Facility | | $1,604.70 | $1,620.06 | $2,247.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.59 / $545.77 / $951.13
| Professional | | $338.59 | $545.77 | $951.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,951.00 / $7,934.00
| Facility | | $1,981.00 | $3,951.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.32 / $588.36 / $1,017.41
| Professional | | $417.32 | $588.36 | $1,017.41 |