- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.24 / $2,994.86 / $7,470.03
| Facility | | $2,038.24 | $2,994.86 | $7,470.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.09 / $203.65 / $428.56
| Professional | | $141.09 | $203.65 | $428.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.57 / $272.70 / $401.83
| Professional | | $189.57 | $272.70 | $401.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.83 / $350.04 / $505.26
| Professional | | $223.83 | $350.04 | $505.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.24 / $329.31 / $548.94
| Professional | | $224.24 | $329.31 | $548.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.24 / $2,994.86 / $7,716.06
| Facility | | $2,038.24 | $2,994.86 | $7,716.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.09 / $203.65 / $428.56
| Professional | | $141.09 | $203.65 | $428.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.96 / $345.38 / $530.07
| Professional | | $244.96 | $345.38 | $530.07 |