- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,162.28 / $9,549.93
| Facility | | $602.56 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $812.83
| Professional | | $281.84 | $371.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,897.79 / $13,489.63
| Facility | | $2,089.30 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $794.33
| Professional | | $263.03 | $407.38 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,122.02 / $2,691.53
| Facility | | $537.03 | $1,122.02 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $1,096.48
| Professional | | $309.03 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,589.25
| Facility | | $1,995.26 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $758.58
| Professional | | $275.42 | $389.05 | $758.58 |