- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.47 / $2,361.89 / $6,293.70
| Facility | | $274.47 | $2,361.89 | $6,293.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.47 / $462.01 / $1,685.08
| Professional | | $240.47 | $462.01 | $1,685.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.40 / $257.77 / $329.10
| Professional | | $231.40 | $257.77 | $329.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.19 / $1,012.19 / $1,012.19
| Facility | | $1,012.19 | $1,012.19 | $1,012.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.96 / $428.63 / $806.57
| Professional | | $240.96 | $428.63 | $806.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.71 / $459.79 / $782.37
| Professional | | $345.71 | $459.79 | $782.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,097.02 / $4,097.02 / $4,097.02
| Facility | | $4,097.02 | $4,097.02 | $4,097.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.21 / $481.74 / $786.85
| Professional | | $339.21 | $481.74 | $786.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.71 / $397.57 / $491.97
| Professional | | $345.71 | $397.57 | $491.97 |