- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $4,677.35 / $8,511.38
| Facility | | $467.74 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $794.33
| Professional | | $151.36 | $263.03 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $489.78
| Professional | | $218.78 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $331.13 / $478.63 / $562.34
| Professional | 50 | $331.13 | $478.63 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $316.23 / $645.65
| Professional | | $138.04 | $316.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $295.12 / $389.05
| Professional | | $177.83 | $295.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $245.47 / $467.74
| Professional | | $138.04 | $245.47 | $467.74 |