- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,897.79 / $11,481.54
| Facility | | $870.96 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $234.42 / $575.44
| Professional | | $194.98 | $234.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $17,378.01
| Facility | | $3,235.94 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $575.44
| Professional | | $208.93 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $691.83 / $1,905.46
| Facility | | $323.59 | $691.83 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $758.58
| Professional | | $239.88 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $537.03
| Professional | | $213.80 | $302.00 | $537.03 |