- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,570.40 / $6,606.93
| Facility | | $794.33 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $288.40 / $501.19
| Professional | | $239.88 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $13,182.57
| Facility | | $5,128.61 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $467.74
| Professional | | $269.15 | $363.08 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,388.44 / $10,715.19
| Facility | | $302.00 | $3,388.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $7,762.47
| Professional | | $234.42 | $338.84 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $954.99
| Professional | | $223.87 | $302.00 | $954.99 |