- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,187.76 / $3,630.78
| Facility | | $616.60 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $125.89 / $302.00
| Professional | | $70.79 | $125.89 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $100.00 / $218.78
| Professional | | $52.48 | $100.00 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,187.76 / $2,951.21
| Facility | | $1,096.48 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $134.90 / $223.87
| Professional | | $85.11 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $123.03 / $239.88
| Professional | | $79.43 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,238.72 / $13,489.63
| Facility | | $2,041.74 | $2,238.72 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $1,071.52
| Professional | | $912.01 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,445.44 / $2,884.03
| Facility | | $741.31 | $1,445.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $117.49 / $208.93
| Professional | | $77.62 | $117.49 | $208.93 |