- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,388.44 / $6,025.60
| Facility | | $794.33 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $1,047.13
| Professional | | $457.09 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $676.08 / $776.25
| Professional | | $645.65 | $676.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,412.54
| Professional | | $32.36 | $33.11 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,047.13 / $1,380.38
| Professional | | $616.60 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,096.48 / $1,479.11
| Professional | | $426.58 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $1,096.48
| Professional | | $645.65 | $758.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $977.24
| Professional | | $467.74 | $616.60 | $977.24 |