- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,090.30 / $8,912.51
| Facility | | $501.19 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $331.13 / $794.33
| Professional | | $204.17 | $331.13 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,623.41 / $13,489.63
| Facility | | $1,737.80 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $380.19 / $724.44
| Professional | | $257.04 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $2,454.71
| Facility | | $371.54 | $758.58 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $416.87 / $741.31
| Professional | | $229.09 | $416.87 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $12,022.64
| Facility | | $1,348.96 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $602.56
| Professional | | $199.53 | $346.74 | $602.56 |