- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,162.28 / $8,912.51
| Facility | | $676.08 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $870.96
| Professional | | $331.13 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,570.88 / $13,489.63
| Facility | | $1,584.89 | $4,570.88 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $870.96
| Professional | | $331.13 | $467.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,258.93 / $3,019.95
| Facility | | $602.56 | $1,258.93 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $1,148.15
| Professional | | $354.81 | $549.54 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,238.72 / $5,370.32
| Facility | | $676.08 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $831.76
| Professional | | $316.23 | $457.09 | $831.76 |