- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,897.79 / $11,481.54
| Facility | | $776.25 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $213.80 / $537.03
| Professional | | $158.49 | $213.80 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,760.83 / $15,135.61
| Facility | | $2,754.23 | $6,760.83 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $302.00 / $1,174.90
| Professional | | $190.55 | $302.00 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $524.81 / $1,548.82
| Facility | | $186.21 | $524.81 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $346.74 / $691.83
| Professional | | $204.17 | $346.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $223.87 / $457.09
| Professional | | $147.91 | $223.87 | $457.09 |