- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,890.45 / $10,715.19
| Facility | | $549.54 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $831.76
| Professional | | $275.42 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $14,791.08
| Facility | | $2,398.83 | $6,918.31 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $891.25
| Professional | | $302.00 | $478.63 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,659.59 / $4,073.80
| Facility | | $549.54 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,230.27
| Professional | | $323.59 | $575.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,471.29
| Facility | | $1,584.89 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $891.25
| Professional | | $281.84 | $457.09 | $891.25 |