- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,365.16 / $10,964.78
| Facility | | $758.58 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $234.42 / $562.34
| Professional | | $204.17 | $234.42 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $13,803.84
| Facility | | $2,754.23 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $562.34
| Professional | | $204.17 | $316.23 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $1,862.09
| Facility | | $354.81 | $645.65 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $691.83
| Professional | | $223.87 | $346.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,174.90 / $3,630.78
| Facility | | $269.15 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $501.19
| Professional | | $190.55 | $275.42 | $501.19 |