- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $4,570.88 / $11,481.54
| Facility | | $380.19 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $275.42 / $575.44
| Professional | | $223.87 | $275.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,120.11 / $26,302.68
| Facility | | $3,981.07 | $9,120.11 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $630.96
| Professional | | $223.87 | $346.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $602.56 / $1,905.46
| Facility | | $239.88 | $602.56 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $870.96
| Professional | | $251.19 | $398.11 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $562.34
| Professional | | $213.80 | $309.03 | $562.34 |