- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,365.16 / $10,964.78
| Facility | | $758.58 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $245.47 / $616.60
| Professional | | $204.17 | $245.47 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $15,135.61
| Facility | | $2,398.83 | $7,079.46 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $588.84
| Professional | | $194.98 | $309.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $776.25 / $12,589.25
| Facility | | $331.13 | $776.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $346.74 / $691.83
| Professional | | $213.80 | $346.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $524.81
| Professional | | $194.98 | $281.84 | $524.81 |