- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,786.30 / $11,220.18
| Facility | | $537.03 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $218.78 / $549.54
| Professional | | $173.78 | $218.78 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $12,589.25
| Facility | | $2,454.71 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $416.87
| Professional | | $162.18 | $223.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $2,290.87
| Facility | | $338.84 | $741.31 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $575.44
| Professional | | $186.21 | $275.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,772.37
| Facility | | $1,047.13 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $218.78 / $398.11
| Professional | | $158.49 | $218.78 | $398.11 |