- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,162.28 / $7,762.47
| Facility | | $257.04 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $281.84 / $870.96
| Professional | | $245.47 | $281.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $2,454.71
| Professional | | $234.42 | $346.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $691.83
| Professional | | $234.42 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $537.03 / $575.44
| Professional | | $229.09 | $537.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,760.83 / $26,302.68
| Facility | | $1,023.29 | $6,760.83 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $407.38 / $676.08
| Professional | | $229.09 | $407.38 | $676.08 |