- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $4,073.80 / $7,762.47
| Facility | | $436.52 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $416.87 / $977.24
| Professional | | $363.08 | $416.87 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,819.70 / $5,370.32
| Professional | | $426.58 | $1,819.70 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $1,148.15
| Professional | | $416.87 | $549.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $831.76 / $954.99
| Professional | | $426.58 | $831.76 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,762.47 / $26,302.68
| Facility | | $2,344.23 | $7,762.47 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $537.03 / $1,148.15
| Professional | | $295.12 | $537.03 | $1,148.15 |