- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $4,677.35 / $11,481.54
| Facility | | $588.84 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $407.38 / $776.25
| Professional | | $338.84 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,754.40 / $13,803.84
| Facility | | $2,454.71 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $954.99
| Professional | | $309.03 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,071.52 / $3,019.95
| Facility | | $323.59 | $1,071.52 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,230.27
| Professional | | $380.19 | $575.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $870.96
| Professional | | $323.59 | $478.63 | $870.96 |