- 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
- $194.98 / $229.09 / $489.78
| Professional | | $194.98 | $229.09 | $489.78 |
- 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
- $190.55 / $288.40 / $549.54
| Professional | | $190.55 | $288.40 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $588.84 / $12,302.69
| Facility | | $223.87 | $588.84 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $346.74 / $676.08
| Professional | | $213.80 | $346.74 | $676.08 |
- 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
- $186.21 / $281.84 / $489.78
| Professional | | $186.21 | $281.84 | $489.78 |