- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.53 / $3,301.91 / $6,664.83
| Facility | | $246.53 | $3,301.91 | $6,664.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.53 / $378.23 / $601.77
| Professional | | $246.53 | $378.23 | $601.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.58 / $501.80 / $702.56
| Professional | | $328.58 | $501.80 | $702.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.96 / $612.17 / $1,041.01
| Professional | | $387.96 | $612.17 | $1,041.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.65 / $570.07 / $887.03
| Professional | | $393.65 | $570.07 | $887.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,301.91 / $5,144.13 / $11,358.06
| Facility | | $3,301.91 | $5,144.13 | $11,358.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.53 / $378.23 / $720.37
| Professional | | $246.53 | $378.23 | $720.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.66 / $663.19 / $1,030.10
| Professional | | $471.66 | $663.19 | $1,030.10 |