- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,786.30 / $11,481.54
| Facility | | $912.01 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $269.15 / $602.56
| Professional | | $223.87 | $269.15 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,317.64 / $16,595.87
| Facility | | $2,187.76 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $602.56
| Professional | | $218.78 | $331.13 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $741.31 / $2,290.87
| Facility | | $380.19 | $741.31 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $371.54 / $794.33
| Professional | | $239.88 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $12,302.69
| Facility | | $1,584.89 | $4,365.16 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $549.54
| Professional | | $208.93 | $309.03 | $549.54 |