- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,897.79 / $11,748.98
| Facility | | $309.03 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $831.76
| Professional | | $186.21 | $251.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,456.54 / $12,589.25
| Facility | | $2,630.27 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $575.44
| Professional | | $208.93 | $316.23 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $891.25 / $2,290.87
| Facility | | $371.54 | $891.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $707.95
| Professional | | $223.87 | $331.13 | $707.95 |
- 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
- $194.98 / $275.42 / $512.86
| Professional | | $194.98 | $275.42 | $512.86 |