- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,344.23 / $4,897.79
| Facility | | $288.40 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $269.15 / $512.86
| Professional | | $229.09 | $269.15 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $18,620.87 / $26,302.68
| Facility | | $9,549.93 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $602.56
| Professional | | $281.84 | $389.05 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $263.03 / $302.00
| Facility | | $257.04 | $263.03 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $346.74 / $630.96
| Professional | | $275.42 | $346.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,623.41 / $12,022.64
| Facility | | $1,412.54 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $323.59 / $489.78
| Professional | | $251.19 | $323.59 | $489.78 |