- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,311.31 / $8,912.51
| Facility | | $588.84 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $912.01
| Professional | | $239.88 | $512.86 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,011.87 / $12,022.64
| Facility | | $1,698.24 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $512.86 / $1,202.26
| Professional | | $275.42 | $512.86 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,698.24 / $4,786.30
| Facility | | $416.87 | $1,698.24 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $575.44 / $1,318.26
| Professional | | $269.15 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,168.69 / $9,549.93
| Facility | | $1,513.56 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $501.19 / $1,023.29
| Professional | | $245.47 | $501.19 | $1,023.29 |