- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,897.79 / $14,125.38
| Facility | | $724.44 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $1,023.29
| Professional | | $467.74 | $549.54 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $13,803.84 / $19,054.61
| Facility | | $4,365.16 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $954.99
| Professional | | $446.68 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $501.19 / $562.34
| Facility | | $478.63 | $501.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $1,096.48
| Professional | | $478.63 | $630.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,762.47 / $10,964.78
| Facility | | $2,951.21 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $912.01
| Professional | | $446.68 | $562.34 | $912.01 |