- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,715.35 / $9,549.93
| Facility | | $776.25 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $380.19 / $851.14
| Professional | | $302.00 | $380.19 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,760.83 / $20,417.38
| Facility | | $2,511.89 | $6,760.83 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $831.76
| Professional | | $213.80 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,148.15 / $3,467.37
| Facility | | $446.68 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $1,148.15
| Professional | | $316.23 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,677.35 / $11,220.18
| Facility | | $1,513.56 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $741.31
| Professional | | $263.03 | $371.54 | $741.31 |