- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $4,073.80 / $10,964.78
| Facility | | $288.40 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $416.87
| Professional | | $120.23 | $229.09 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $15,848.93
| Facility | | $2,884.03 | $7,413.10 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $257.04 / $537.03
| Professional | | $138.04 | $257.04 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $758.58 / $3,235.94
| Facility | | $151.36 | $758.58 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $316.23 / $707.95
| Professional | | $158.49 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,589.25
| Facility | | $1,995.26 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $245.47 / $524.81
| Professional | | $131.83 | $245.47 | $524.81 |