- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $4,466.84 / $10,964.78
| Facility | | $436.52 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $295.12 / $549.54
| Professional | | $245.47 | $295.12 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $13,803.84
| Facility | | $2,570.40 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $588.84
| Professional | | $239.88 | $331.13 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $1,819.70
| Facility | | $363.08 | $575.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $776.25
| Professional | | $263.03 | $380.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $562.34
| Professional | | $223.87 | $316.23 | $562.34 |