- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,897.79 / $7,244.36
| Facility | | $309.03 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $288.40 / $691.83
| Professional | | $257.04 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $18,197.01 / $26,302.68
| Facility | | $2,818.38 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $616.60
| Professional | | $263.03 | $398.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $275.42 / $316.23
| Facility | | $263.03 | $275.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $691.83
| Professional | | $269.15 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $10,715.19
| Facility | | $3,388.44 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $537.03
| Professional | | $257.04 | $323.59 | $537.03 |