- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $147.91 / $257.04
| Professional | | $125.89 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $234.42 / $338.84
| Professional | | $141.25 | $234.42 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $257.04 / $3,890.45
| Facility | | $138.04 | $257.04 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $186.21 / $1,862.09
| Professional | | $123.03 | $186.21 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,981.07
| Facility | | $575.44 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $158.49 / $275.42
| Professional | | $112.20 | $158.49 | $275.42 |