- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $7,943.28
| Facility | | $776.25 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $512.86 / $1,047.13
| Professional | | $257.04 | $512.86 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $812.83
| Professional | | $380.19 | $537.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,122.02
| Professional | | $436.52 | $676.08 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $954.99
| Professional | | $346.74 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $7,943.28
| Facility | | $776.25 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $537.03 / $1,230.27
| Professional | | $275.42 | $537.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $954.99
| Professional | | $346.74 | $602.56 | $954.99 |