- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,365.16 / $10,964.78
| Facility | | $758.58 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $199.53 / $478.63
| Professional | | $169.82 | $199.53 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $13,803.84
| Facility | | $2,754.23 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $257.04 / $478.63
| Professional | | $169.82 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $2,290.87
| Facility | | $309.03 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $616.60
| Professional | | $186.21 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,174.90 / $3,630.78
| Facility | | $269.15 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $426.58
| Professional | | $162.18 | $234.42 | $426.58 |