- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $9,772.37
| Facility | | $933.25 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $331.13
| Professional | | $181.97 | $263.03 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $11,748.98
| Facility | | $1,819.70 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $346.74
| Professional | | $120.23 | $177.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $19,952.62
| Facility | | $467.74 | $467.74 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,318.26 / $1,318.26
| Professional | | $316.23 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,148.15 / $3,467.37
| Facility | | $295.12 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $630.96
| Professional | | $245.47 | $354.81 | $630.96 |