- 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
- $239.88 / $269.15 / $446.68
| Professional | | $239.88 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $457.09
| Professional | | $234.42 | $331.13 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $3,890.45
| Facility | | $251.19 | $398.11 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $302.00 / $1,905.46
| Professional | | $234.42 | $302.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,187.76 / $4,168.69
| Facility | | $575.44 | $2,187.76 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $416.87
| Professional | | $218.78 | $281.84 | $416.87 |