- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,467.37 / $9,772.37
| Facility | | $691.83 | $3,467.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $691.83 / $2,884.03
| Professional | | $186.21 | $691.83 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,737.80 / $3,019.95
| Facility | | $1,584.89 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $512.86 / $1,479.11
| Professional | | $173.78 | $512.86 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $676.08 / $2,238.72
| Professional | | $234.42 | $676.08 | $2,238.72 |
- 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
- $213.80 / $831.76 / $1,905.46
| Professional | | $213.80 | $831.76 | $1,905.46 |
- 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
- $251.19 / $831.76 / $2,238.72
| Professional | | $251.19 | $831.76 | $2,238.72 |