- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,715.35 / $9,772.37
| Facility | | $794.33 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $794.33
| Professional | | $331.13 | $398.11 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,754.40 / $13,489.63
| Facility | | $2,238.72 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $831.76
| Professional | | $323.59 | $478.63 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $2,511.89
| Facility | | $524.81 | $891.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $1,023.29
| Professional | | $354.81 | $524.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,890.45 / $9,120.11
| Facility | | $1,047.13 | $3,890.45 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $776.25
| Professional | | $309.03 | $446.68 | $776.25 |