- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $5,888.44 / $10,964.78
| Facility | | $489.78 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $707.95
| Professional | | $239.88 | $346.74 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $524.81 / $630.96
| Professional | | $281.84 | $524.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $436.52 / $912.01
| Professional | | $229.09 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $389.05 / $575.44
| Professional | | $229.09 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $724.44
| Professional | | $245.47 | $331.13 | $724.44 |