- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $7,079.46 / $12,882.50
| Facility | | $912.01 | $7,079.46 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $691.83
| Professional | | $190.55 | $263.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $524.81
| Professional | | $223.87 | $389.05 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $562.34
| Professional | | $275.42 | $371.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $489.78
| Professional | | $398.11 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $309.03 / $537.03
| Professional | | $223.87 | $309.03 | $537.03 |