- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,365.16 / $10,964.78
| Facility | | $812.83 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $416.87 / $794.33
| Professional | | $346.74 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,317.64 / $16,982.44
| Facility | | $3,311.31 | $8,317.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $891.25
| Professional | | $338.84 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,621.81 / $10,232.93
| Facility | | $645.65 | $1,621.81 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $1,071.52
| Professional | | $354.81 | $549.54 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $8,317.64 / $19,054.61
| Facility | | $2,137.96 | $8,317.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $831.76
| Professional | | $323.59 | $467.74 | $831.76 |