- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $4,073.80 / $7,762.47
| Facility | | $288.40 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $331.13 / $891.25
| Professional | | $288.40 | $331.13 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $2,818.38
| Professional | | $380.19 | $537.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $891.25
| Professional | | $316.23 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $338.84 / $794.33
| Professional | | $323.59 | $338.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,489.63 / $26,302.68
| Facility | | $2,344.23 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $407.38 / $870.96
| Professional | | $288.40 | $407.38 | $870.96 |