- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,760.83 / $10,471.29
| Facility | | $478.63 | $6,760.83 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $660.69 / $3,548.13
| Professional | | $245.47 | $660.69 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $501.19 / $3,090.30
| Professional | | $239.88 | $501.19 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $3,890.45
| Professional | | $309.03 | $537.03 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $2,187.76 / $3,801.89
| Professional | | $269.15 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $5,623.41 / $10,471.29
| Facility | | $478.63 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $851.14 / $3,548.13
| Professional | | $251.19 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,548.82 / $3,890.45
| Professional | | $331.13 | $1,548.82 | $3,890.45 |