- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,715.35 / $10,715.19
| Facility | | $446.68 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $891.25
| Professional | | $302.00 | $407.38 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $891.25
| Professional | | $323.59 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $724.44 / $3,388.44
| Facility | | $223.87 | $724.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $1,202.26
| Professional | | $338.84 | $537.03 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $851.14
| Professional | | $309.03 | $457.09 | $851.14 |