- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,174.90 / $3,467.37
| Professional | | $169.82 | $1,174.90 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,220.18 / $15,488.17
| Facility | | $9,549.93 | $11,220.18 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $1,288.25 / $2,238.72
| Professional | | $141.25 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $645.65 / $3,019.95
| Professional | | $173.78 | $645.65 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,318.26 / $2,344.23
| Professional | | $147.91 | $1,318.26 | $2,344.23 |