- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,570.88 / $11,481.54
| Facility | | $616.60 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $489.78 / $912.01
| Professional | | $251.19 | $489.78 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,456.54 / $14,125.38
| Facility | | $2,290.87 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $467.74 / $977.24
| Professional | | $275.42 | $467.74 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,380.38 / $3,801.89
| Facility | | $323.59 | $1,380.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $588.84 / $1,380.38
| Professional | | $309.03 | $588.84 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,570.88 / $10,964.78
| Facility | | $1,584.89 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $977.24
| Professional | | $257.04 | $446.68 | $977.24 |