- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,698.24 / $5,011.87
| Facility | | $467.74 | $1,698.24 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $398.11 / $912.01
| Professional | | $208.93 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $2,818.38 / $6,456.54
| Professional | | $229.09 | $2,818.38 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $1,096.48
| Professional | | $204.17 | $354.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $389.05 / $851.14
| Professional | | $371.54 | $389.05 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $14,454.40 / $26,915.35
| Facility | | $3,311.31 | $14,454.40 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $331.13 / $741.31
| Professional | | $186.21 | $331.13 | $741.31 |