- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,365.16 / $10,964.78
| Facility | | $758.58 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $660.69
| Professional | | $245.47 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $13,489.63
| Facility | | $2,691.53 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $645.65
| Professional | | $245.47 | $354.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $933.25 / $2,238.72
| Facility | | $446.68 | $933.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $870.96
| Professional | | $263.03 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $616.60
| Professional | | $234.42 | $338.84 | $616.60 |