- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,897.79 / $11,220.18
| Facility | | $524.81 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $338.84 / $1,071.52
| Professional | | $251.19 | $338.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,709.64 / $17,378.01
| Facility | | $3,235.94 | $8,709.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $575.44
| Professional | | $223.87 | $316.23 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $891.25 / $4,570.88
| Facility | | $457.09 | $891.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $371.54 / $758.58
| Professional | | $251.19 | $371.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,265.80 / $10,715.19
| Facility | | $1,047.13 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $549.54
| Professional | | $218.78 | $302.00 | $549.54 |