- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $4,897.79 / $16,218.10
| Facility | | $426.58 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $776.25
| Professional | | $295.12 | $354.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $23,988.33 / $33,113.11
| Facility | | $4,570.88 | $23,988.33 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $724.44
| Professional | | $316.23 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $309.03 / $354.81
| Facility | | $295.12 | $309.03 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $891.25
| Professional | | $316.23 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $575.44
| Professional | | $281.84 | $354.81 | $575.44 |