- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,162.28 / $7,762.47
| Facility | | $295.12 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $281.84 / $436.52
| Professional | | $245.47 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $288.40 / $1,380.38
| Professional | | $245.47 | $288.40 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $724.44
| Professional | | $245.47 | $331.13 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $251.19 / $575.44
| Professional | | $239.88 | $251.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,606.93 / $29,512.09
| Facility | | $1,023.29 | $6,606.93 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $630.96
| Professional | | $218.78 | $281.84 | $630.96 |