- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,715.35 / $9,549.93
| Facility | | $602.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $302.00 / $660.69
| Professional | | $239.88 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $11,220.18
| Facility | | $1,819.70 | $5,011.87 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $354.81 / $676.08
| Professional | | $213.80 | $354.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $831.76 / $2,290.87
| Facility | | $426.58 | $831.76 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $891.25
| Professional | | $263.03 | $416.87 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,918.31
| Facility | | $1,023.29 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $602.56
| Professional | | $223.87 | $331.13 | $602.56 |