- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,288.25 / $3,890.45
| Facility | | $501.19 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $691.83
| Professional | | $338.84 | $436.52 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,511.38 / $19,054.61
| Facility | | $3,981.07 | $8,511.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $691.83
| Professional | | $407.38 | $549.54 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $676.08
| Professional | | $338.84 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,754.23 / $11,481.54
| Facility | | $831.76 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $758.58
| Professional | | $323.59 | $457.09 | $758.58 |