- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,897.79 / $11,481.54
| Facility | | $794.33 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $323.59 / $724.44
| Professional | | $229.09 | $323.59 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $18,197.01
| Facility | | $3,311.31 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $467.74 / $2,089.30
| Professional | | $218.78 | $467.74 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $891.25 / $2,630.27
| Facility | | $257.04 | $891.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $512.86 / $1,096.48
| Professional | | $288.40 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $338.84 / $645.65
| Professional | | $223.87 | $338.84 | $645.65 |