- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,467.37 / $11,220.18
| Facility | | $446.68 | $3,467.37 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $851.14
| Professional | | $323.59 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $371.54
| Professional | | $302.00 | $302.00 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $19,054.61
| Facility | | $3,715.35 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $630.96
| Professional | | $263.03 | $371.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $354.81 / $407.38
| Facility | | $323.59 | $354.81 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,905.46
| Facility | | $1,621.81 | $1,621.81 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $812.83
| Professional | | $363.08 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,715.35 / $6,456.54
| Facility | | $2,398.83 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $758.58
| Professional | | $309.03 | $446.68 | $758.58 |