- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,786.30 / $11,481.54
| Facility | | $724.44 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $275.42 / $660.69
| Professional | | $223.87 | $275.42 | $660.69 |
- 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
- $208.93 / $295.12 / $537.03
| Professional | | $208.93 | $295.12 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $933.25 / $2,290.87
| Facility | | $416.87 | $933.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $691.83
| Professional | | $234.42 | $338.84 | $691.83 |
- 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
- $199.53 / $281.84 / $501.19
| Professional | | $199.53 | $281.84 | $501.19 |