- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,365.16 / $10,715.19
| Facility | | $812.83 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $467.74
| Professional | | $186.21 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $18,620.87
| Facility | | $2,187.76 | $6,918.31 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $524.81
| Professional | | $177.83 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $562.34 / $12,302.69
| Facility | | $208.93 | $562.34 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $331.13 / $645.65
| Professional | | $204.17 | $331.13 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,754.40 / $14,125.38
| Facility | | $1,905.46 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $269.15 / $467.74
| Professional | | $173.78 | $269.15 | $467.74 |