- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,511.89 / $7,762.47
| Facility | | $812.83 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $177.83 / $741.31
| Professional | | $117.49 | $177.83 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $15,135.61
| Facility | | $8,912.51 | $12,589.25 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $331.13 / $331.13
| Professional | | $275.42 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $446.68
| Professional | | $208.93 | $331.13 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $281.84 / $309.03
| Professional | | $275.42 | $281.84 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,370.32 / $12,302.69
| Facility | | $1,445.44 | $5,370.32 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $275.42 / $436.52
| Professional | | $141.25 | $275.42 | $436.52 |