- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,715.35 / $9,549.93
| Facility | | $707.95 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $316.23 / $691.83
| Professional | | $257.04 | $316.23 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,025.60 / $14,125.38
| Facility | | $1,819.70 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $707.95
| Professional | | $251.19 | $380.19 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $977.24 / $2,630.27
| Facility | | $467.74 | $977.24 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $912.01
| Professional | | $275.42 | $426.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,964.78
| Facility | | $1,584.89 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $645.65
| Professional | | $245.47 | $354.81 | $645.65 |