- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,137.96 / $7,762.47
| Facility | | $380.19 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $436.52
| Professional | | $213.80 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,202.26 / $4,897.79
| Professional | | $234.42 | $1,202.26 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $346.74 / $794.33
| Professional | | $323.59 | $346.74 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $13,489.63 / $26,915.35
| Facility | | $3,311.31 | $13,489.63 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $812.83
| Professional | | $218.78 | $363.08 | $812.83 |