- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,981.07 / $10,964.78
| Facility | | $478.63 | $3,981.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $407.38 / $812.83
| Professional | | $257.04 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $616.60
| Professional | | $281.84 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $3,801.89
| Facility | | $467.74 | $467.74 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $794.33
| Professional | | $309.03 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $1,071.52
| Professional | | $269.15 | $436.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $467.74
| Professional | | $269.15 | $416.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $11,481.54
| Facility | | $2,630.27 | $6,025.60 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $831.76
| Professional | | $302.00 | $478.63 | $831.76 |