- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,090.30 / $8,511.38
| Facility | | $512.86 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $1,174.90
| Professional | | $295.12 | $489.78 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $10,964.78
| Facility | | $1,819.70 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $851.14
| Professional | | $309.03 | $478.63 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $954.99 / $3,715.35
| Facility | | $478.63 | $954.99 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $1,230.27
| Professional | | $338.84 | $562.34 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,168.69 / $9,549.93
| Facility | | $1,348.96 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $891.25
| Professional | | $295.12 | $467.74 | $891.25 |