- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $4,365.16 / $10,715.19
| Facility | | $741.31 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $645.65
| Professional | | $229.09 | $281.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,165.95 / $12,302.69
| Facility | | $2,089.30 | $6,165.95 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $676.08
| Professional | | $218.78 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,905.46
| Facility | | $398.11 | $758.58 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $794.33
| Professional | | $245.47 | $398.11 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,238.72 / $5,370.32
| Facility | | $676.08 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $323.59 / $588.84
| Professional | | $223.87 | $323.59 | $588.84 |