- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,365.16 / $10,964.78
| Facility | | $851.14 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $977.24
| Professional | | $354.81 | $416.87 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $977.24
| Professional | | $338.84 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,122.02 / $3,019.95
| Facility | | $562.34 | $1,122.02 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,288.25
| Professional | | $389.05 | $575.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $870.96
| Professional | | $323.59 | $457.09 | $870.96 |