- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,801.89 / $7,244.36
| Facility | | $251.19 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $1,230.27 / $2,884.03
| Professional | | $208.93 | $1,230.27 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $1,148.15 / $2,818.38
| Professional | | $257.04 | $1,148.15 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $223.87 / $257.04
| Facility | | $218.78 | $223.87 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,621.81 / $3,090.30
| Professional | | $234.42 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,715.35 / $6,456.54
| Facility | | $1,698.24 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,951.21
| Professional | | $218.78 | $1,202.26 | $2,951.21 |