- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,754.23 / $4,073.80
| Facility | | $398.11 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $676.08
| Professional | | $234.42 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $380.19 / $3,548.13
| Professional | | $257.04 | $380.19 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $933.25
| Professional | | $251.19 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $891.25
| Professional | | $467.74 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,606.93 / $26,302.68
| Facility | | $1,023.29 | $6,606.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $436.52 / $891.25
| Professional | | $223.87 | $436.52 | $891.25 |