- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,715.35 / $10,715.19
| Facility | | $416.87 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $794.33
| Professional | | $281.84 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,495.41 / $12,022.64
| Facility | | $2,187.76 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $794.33
| Professional | | $245.47 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $2,344.23
| Facility | | $346.74 | $537.03 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,047.13
| Professional | | $281.84 | $467.74 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,309.57 / $15,135.61
| Facility | | $1,737.80 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $398.11 / $758.58
| Professional | | $257.04 | $398.11 | $758.58 |