- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $4,365.16 / $10,964.78
| Facility | | $707.95 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $354.81
| Professional | | $120.23 | $151.36 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,585.78 / $16,595.87
| Facility | | $2,454.71 | $7,585.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $199.53 / $363.08
| Professional | | $123.03 | $199.53 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $851.14 / $17,378.01
| Facility | | $204.17 | $851.14 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $223.87 / $416.87
| Professional | | $131.83 | $223.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,511.38 / $18,620.87
| Facility | | $3,019.95 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $316.23
| Professional | | $117.49 | $186.21 | $316.23 |