- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,570.88 / $7,413.10
| Facility | | $676.08 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $660.69
| Professional | | $199.53 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $645.65
| Professional | | $257.04 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $426.58 / $691.83
| Professional | | $245.47 | $426.58 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $524.81
| Professional | | $446.68 | $446.68 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $602.56
| Professional | | $204.17 | $309.03 | $602.56 |