- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $5,495.41 / $7,762.47
| Facility | | $363.08 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $912.01
| Professional | | $239.88 | $363.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $4,365.16 / $9,120.11
| Professional | | $363.08 | $4,365.16 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $794.33
| Professional | | $302.00 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $288.40 / $691.83
| Professional | | $275.42 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $33,884.42
| Facility | | $3,311.31 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $794.33
| Professional | | $275.42 | $407.38 | $794.33 |