- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $6,025.60 / $12,022.64
| Facility | | $354.81 | $6,025.60 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $954.99
| Professional | | $245.47 | $323.59 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $11,481.54 / $23,988.33
| Facility | | $6,025.60 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $524.81
| Professional | | $269.15 | $363.08 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $2,630.27
| Facility | | $794.33 | $794.33 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $524.81
| Professional | | $269.15 | $354.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $1,202.26
| Professional | | $251.19 | $354.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $489.78
| Professional | | $251.19 | $251.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,623.41 / $11,481.54
| Facility | | $2,454.71 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $562.34
| Professional | | $263.03 | $363.08 | $562.34 |