- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,365.16 / $14,791.08
| Facility | | $660.69 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,230.27
| Professional | | $660.69 | $660.69 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $3.24 / $3.80
| Professional | | $0.02 | $3.24 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $2,454.71
| Professional | | $691.83 | $912.01 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,258.93
| Facility | | $660.69 | $977.24 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $10,964.78
| Facility | | $2,454.71 | $3,715.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $10,964.78
| Professional | | $2,454.71 | $3,715.35 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |