- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $3,801.89 / $10,232.93
| Facility | | $331.13 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $257.04 / $588.84
| Professional | | $194.98 | $257.04 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,248.07 / $10,964.78
| Facility | | $1,905.46 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $562.34
| Professional | | $186.21 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $812.83 / $2,041.74
| Facility | | $257.04 | $812.83 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $338.84 / $741.31
| Professional | | $213.80 | $338.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $524.81
| Professional | | $190.55 | $281.84 | $524.81 |