- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,981.07 / $10,715.19
| Facility | | $446.68 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $363.08 / $676.08
| Professional | | $223.87 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,025.60 / $12,302.69
| Facility | | $1,905.46 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $660.69
| Professional | | $213.80 | $331.13 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $870.96 / $2,570.40
| Facility | | $363.08 | $870.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $398.11 / $851.14
| Professional | | $239.88 | $398.11 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $616.60
| Professional | | $208.93 | $338.84 | $616.60 |