- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,344.23 / $4,897.79
| Facility | | $245.47 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $398.11
| Professional | | $223.87 | $263.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $489.78
| Professional | | $234.42 | $323.59 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $234.42 / $251.19
| Facility | | $213.80 | $234.42 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $323.59 / $478.63
| Professional | | $229.09 | $323.59 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $478.63
| Professional | | $213.80 | $302.00 | $478.63 |