- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,981.07 / $6,456.54
| Facility | | $524.81 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $1,096.48
| Professional | | $251.19 | $512.86 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $3,235.94 / $7,079.46
| Professional | | $524.81 | $3,235.94 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $954.99
| Professional | | $354.81 | $467.74 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $831.76 / $831.76
| Professional | | $758.58 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $12,882.50 / $26,915.35
| Facility | | $3,311.31 | $12,882.50 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,071.52
| Professional | | $346.74 | $512.86 | $1,071.52 |