- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $5,128.61 / $11,748.98
| Facility | | $501.19 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $147.91 / $467.74
| Professional | | $107.15 | $147.91 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $10,471.29
| Facility | | $2,344.23 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $181.97 / $331.13
| Professional | | $117.49 | $181.97 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $457.09 / $2,290.87
| Facility | | $223.87 | $457.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $416.87
| Professional | | $134.90 | $204.17 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $169.82 / $302.00
| Professional | | $120.23 | $169.82 | $302.00 |