- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,677.35 / $10,964.78
| Facility | | $660.69 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $1,380.38
| Professional | | $275.42 | $389.05 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,762.47 / $16,982.44
| Facility | | $2,884.03 | $7,762.47 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $489.78 / $891.25
| Professional | | $275.42 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,862.09 / $11,748.98
| Facility | | $537.03 | $1,862.09 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $524.81 / $1,023.29
| Professional | | $323.59 | $524.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,182.57
| Facility | | $1,995.26 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $758.58
| Professional | | $295.12 | $446.68 | $758.58 |