- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,365.16 / $10,715.19
| Facility | | $831.76 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $977.24
| Professional | | $389.05 | $457.09 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,025.60 / $12,302.69
| Facility | | $1,949.84 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $912.01
| Professional | | $346.74 | $489.78 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,202.26 / $2,691.53
| Facility | | $549.54 | $1,202.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $1,202.26
| Professional | | $363.08 | $562.34 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $870.96
| Professional | | $338.84 | $478.63 | $870.96 |