- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $4,897.79 / $11,220.18
| Facility | | $281.84 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $251.19 / $630.96
| Professional | | $218.78 | $251.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $537.03
| Professional | | $251.19 | $346.74 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $251.19 / $281.84
| Facility | | $239.88 | $251.19 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $645.65
| Professional | | $251.19 | $354.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $281.84 / $446.68
| Professional | | $234.42 | $281.84 | $446.68 |