- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,090.30 / $8,511.38
| Facility | | $389.05 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $741.31
| Professional | | $223.87 | $346.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $13,489.63
| Facility | | $1,995.26 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $707.95
| Professional | | $251.19 | $389.05 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,023.29 / $2,511.89
| Facility | | $354.81 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $436.52 / $933.25
| Professional | | $257.04 | $436.52 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,019.95 / $6,918.31
| Facility | | $1,023.29 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $676.08
| Professional | | $218.78 | $354.81 | $676.08 |