- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,677.35 / $12,022.64
| Facility | | $398.11 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $275.42 / $512.86
| Professional | | $223.87 | $275.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $9,772.37 / $20,417.38
| Facility | | $2,344.23 | $9,772.37 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $676.08
| Professional | | $223.87 | $354.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $676.08 / $1,819.70
| Facility | | $323.59 | $676.08 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $758.58
| Professional | | $245.47 | $389.05 | $758.58 |
- 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
- $218.78 / $338.84 / $575.44
| Professional | | $218.78 | $338.84 | $575.44 |