- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $10,715.19 / $14,125.38
| Facility | | $389.05 | $10,715.19 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $630.96 / $1,096.48
| Professional | | $120.23 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $2,290.87
| Professional | | $457.09 | $457.09 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $912.01 / $4,073.80
| Facility | | $177.83 | $912.01 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,047.13 / $3,801.89
| Professional | | $263.03 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $4,265.80
| Professional | | $501.19 | $831.76 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $933.25 / $4,073.80
| Facility | | $229.09 | $933.25 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $177.83 / $2,290.87
| Professional | | $60.26 | $177.83 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,230.27 / $4,570.88
| Professional | | $316.23 | $1,230.27 | $4,570.88 |