- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,981.07 / $10,715.19
| Facility | | $575.44 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $891.25
| Professional | | $309.03 | $436.52 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $12,589.25
| Facility | | $2,454.71 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $831.76
| Professional | | $263.03 | $416.87 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,202.26 / $3,311.31
| Facility | | $457.09 | $1,202.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $537.03 / $1,148.15
| Professional | | $331.13 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $15,488.17
| Facility | | $2,398.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $831.76
| Professional | | $288.40 | $436.52 | $831.76 |