- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,388.44 / $9,120.11
| Facility | | $616.60 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $912.01
| Professional | | $331.13 | $501.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $933.25
| Professional | | $338.84 | $489.78 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,513.56 / $3,235.94
| Facility | | $588.84 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $1,202.26
| Professional | | $346.74 | $562.34 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,606.93
| Facility | | $645.65 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $870.96
| Professional | | $309.03 | $478.63 | $870.96 |