- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $5,248.07 / $13,489.63
| Facility | | $436.52 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $630.96
| Professional | | $208.93 | $346.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,677.35 / $10,471.29
| Facility | | $2,290.87 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $616.60
| Professional | | $204.17 | $302.00 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,380.38 / $3,090.30
| Facility | | $371.54 | $1,380.38 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $371.54 / $794.33
| Professional | | $218.78 | $371.54 | $794.33 |
- 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
- $190.55 / $316.23 / $588.84
| Professional | | $190.55 | $316.23 | $588.84 |