- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,023.29 / $9,772.37
| Facility | | $524.81 | $1,023.29 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $1,318.26
| Professional | | $398.11 | $457.09 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $1,202.26
| Professional | | $426.58 | $851.14 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $933.25 / $1,348.96
| Professional | | $316.23 | $933.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,348.96
| Professional | | $489.78 | $776.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,513.56
| Professional | | $524.81 | $776.25 | $1,513.56 |