- 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 / $398.11 / $870.96
| Professional | | $331.13 | $398.11 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $13,803.84
| Facility | | $1,621.81 | $4,897.79 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $891.25
| Professional | | $309.03 | $478.63 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $3,019.95
| Facility | | $537.03 | $1,096.48 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $1,174.90
| Professional | | $354.81 | $549.54 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,964.78
| Facility | | $1,584.89 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $812.83
| Professional | | $309.03 | $457.09 | $812.83 |