- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,238.72 / $10,471.29
| Facility | | $371.54 | $2,238.72 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $389.05 / $912.01
| Professional | | $323.59 | $389.05 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,511.38 / $11,220.18
| Facility | | $3,981.07 | $8,511.38 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $363.08 / $741.31
| Professional | | $309.03 | $363.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $363.08 / $407.38
| Facility | | $346.74 | $363.08 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $776.25
| Professional | | $354.81 | $457.09 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $645.65
| Professional | | $331.13 | $416.87 | $645.65 |