- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,248.07 / $14,454.40
| Facility | | $933.25 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $204.17 / $512.86
| Professional | | $165.96 | $204.17 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $26,302.68
| Facility | | $4,570.88 | $9,332.54 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $478.63
| Professional | | $162.18 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,122.02 / $39,810.72
| Facility | | $281.84 | $1,122.02 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $562.34
| Professional | | $177.83 | $288.40 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,892.96
| Facility | | $3,019.95 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $416.87
| Professional | | $158.49 | $234.42 | $416.87 |