- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $8,912.51
| Facility | | $933.25 | $3,467.37 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $933.25
| Professional | | $537.03 | $645.65 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $21,379.62 / $30,902.95
| Facility | | $12,589.25 | $21,379.62 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $851.14
| Professional | | $588.84 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,148.15
| Professional | | $478.63 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,079.46 / $16,218.10
| Facility | | $1,202.26 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $1,258.93
| Professional | | $537.03 | $741.31 | $1,258.93 |