- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,365.16 / $10,715.19
| Facility | | $794.33 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $630.96
| Professional | | $263.03 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,454.40
| Facility | | $2,754.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $676.08
| Professional | | $269.15 | $380.19 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $812.83 / $4,570.88
| Facility | | $478.63 | $812.83 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $794.33
| Professional | | $275.42 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,762.47 / $18,197.01
| Facility | | $2,137.96 | $7,762.47 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $616.60
| Professional | | $239.88 | $346.74 | $616.60 |