- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,235.94 / $8,912.51
| Facility | | $245.47 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $251.19 / $537.03
| Professional | | $204.17 | $251.19 | $537.03 |
- 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
- $234.42 / $302.00 / $416.87
| Professional | | $234.42 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $436.52
| Professional | | $245.47 | $323.59 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $288.40 / $891.25
| Professional | | $281.84 | $288.40 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $213.80
| Professional | | $204.17 | $204.17 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,754.40 / $12,302.69
| Facility | | $2,630.27 | $5,754.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $323.59 / $537.03
| Professional | | $251.19 | $323.59 | $537.03 |