- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,471.29
| Facility | | $851.14 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $707.95
| Professional | | $229.09 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,748.98 / $13,803.84
| Facility | | $6,606.93 | $11,748.98 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $524.81 / $724.44
| Professional | | $295.12 | $524.81 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $912.01
| Professional | | $309.03 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $741.31
| Professional | | $512.86 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $794.33
| Professional | | $269.15 | $398.11 | $794.33 |