- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $10,471.29
| Facility | | $933.25 | $3,467.37 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $2,691.53
| Professional | | $389.05 | $831.76 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $8,709.64 / $12,302.69
| Facility | | $4,897.79 | $8,709.64 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $2,818.38
| Professional | | $501.19 | $794.33 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $14,791.08 / $14,791.08
| Facility | | $39.81 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $741.31 / $2,884.03
| Professional | | $398.11 | $741.31 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,079.46 / $16,218.10
| Facility | | $1,202.26 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,778.28 / $3,801.89
| Professional | | $407.38 | $1,778.28 | $3,801.89 |