- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $7,079.46 / $14,125.38
| Facility | | $741.31 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $741.31
| Professional | | $245.47 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $1,096.48
| Professional | | $295.12 | $416.87 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $1,288.25
| Facility | | $281.84 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $954.99 / $1,905.46
| Professional | | $575.44 | $954.99 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,318.26 / $1,995.26
| Professional | | $741.31 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $1,288.25
| Facility | | $309.03 | $457.09 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $549.54 / $1,096.48
| Professional | | $239.88 | $549.54 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $645.65 / $1,905.46
| Professional | | $257.04 | $645.65 | $1,905.46 |