- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $4,466.84 / $10,964.78
| Facility | | $741.31 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $165.96 / $407.38
| Professional | | $134.90 | $165.96 | $407.38 |
- 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
- $131.83 / $208.93 / $398.11
| Professional | | $131.83 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $524.81 / $12,589.25
| Facility | | $234.42 | $524.81 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $457.09
| Professional | | $144.54 | $239.88 | $457.09 |
- 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
- $131.83 / $190.55 / $346.74
| Professional | | $131.83 | $190.55 | $346.74 |