- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,248.07 / $12,022.64
| Facility | | $933.25 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $208.93 / $512.86
| Professional | | $181.97 | $208.93 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,248.07 / $12,022.64
| Facility | | $1,905.46 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $602.56
| Professional | | $199.53 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $660.69 / $1,659.59
| Facility | | $323.59 | $660.69 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $691.83
| Professional | | $213.80 | $363.08 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $302.00 / $524.81
| Professional | | $181.97 | $302.00 | $524.81 |