- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,235.94 / $8,317.64
| Facility | | $676.08 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $812.83 / $3,981.07
| Professional | | $104.71 | $812.83 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,332.54 / $12,882.50
| Facility | | $7,244.36 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,073.80 / $5,623.41
| Professional | | $3,467.37 | $4,073.80 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $691.83
| Facility | | $107.15 | $107.15 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,709.64 / $10,964.78
| Facility | | $5,128.61 | $8,709.64 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,709.64 / $10,964.78
| Professional | | $5,128.61 | $8,709.64 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |