- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,897.79 / $12,022.64
| Facility | | $812.83 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $933.25
| Professional | | $323.59 | $407.38 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,511.38 / $18,197.01
| Facility | | $3,090.30 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $933.25
| Professional | | $309.03 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,691.53 / $16,982.44
| Facility | | $630.96 | $2,691.53 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,202.26
| Professional | | $371.54 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $831.76
| Professional | | $323.59 | $457.09 | $831.76 |