- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,897.79 / $11,481.54
| Facility | | $933.25 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $1,258.93
| Professional | | $302.00 | $389.05 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $15,135.61
| Facility | | $2,754.23 | $7,079.46 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $616.60 / $4,677.35
| Professional | | $338.84 | $616.60 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $602.56 / $3,715.35
| Facility | | $323.59 | $602.56 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,698.24
| Professional | | $354.81 | $575.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,818.38 / $9,549.93
| Facility | | $512.86 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $776.25
| Professional | | $263.03 | $407.38 | $776.25 |