- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,380.38 / $9,772.37
| Facility | | $616.60 | $1,380.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $398.11 / $776.25
| Professional | | $346.74 | $398.11 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,964.78 / $16,982.44
| Facility | | $3,890.45 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $741.31 / $1,096.48
| Professional | | $346.74 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $630.96 / $1,047.13
| Professional | | $416.87 | $630.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $912.01
| Professional | | $398.11 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,023.29
| Professional | | $380.19 | $575.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $467.74
| Facility | | $275.42 | $380.19 | $467.74 |