- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,311.31 / $8,709.64
| Facility | | $363.08 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $812.83
| Professional | | $234.42 | $331.13 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,489.63
| Facility | | $1,995.26 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $645.65
| Professional | | $251.19 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,202.26 / $2,884.03
| Facility | | $457.09 | $1,202.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $831.76
| Professional | | $257.04 | $389.05 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $9,772.37
| Facility | | $1,584.89 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $630.96
| Professional | | $229.09 | $338.84 | $630.96 |