- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,370.32 / $7,943.28
| Facility | | $575.44 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $575.44
| Professional | | $218.78 | $281.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,090.30 / $6,025.60
| Facility | | $1,318.26 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $501.19
| Professional | | $234.42 | $371.54 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $602.56
| Professional | | $275.42 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $758.58
| Professional | | $218.78 | $281.84 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $10,715.19
| Facility | | $1,122.02 | $4,168.69 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $602.56
| Professional | | $239.88 | $323.59 | $602.56 |