- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,981.07 / $10,715.19
| Facility | | $436.52 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $660.69
| Professional | | $204.17 | $316.23 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,801.89 / $9,549.93
| Facility | | $1,819.70 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $338.84 / $691.83
| Professional | | $213.80 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $977.24 / $2,754.23
| Facility | | $281.84 | $977.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $389.05 / $891.25
| Professional | | $234.42 | $389.05 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $630.96
| Professional | | $208.93 | $331.13 | $630.96 |