- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,677.35 / $7,413.10
| Facility | | $537.03 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $234.42 / $549.54
| Professional | | $117.49 | $234.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $10,964.78
| Facility | | $3,630.78 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $501.19
| Professional | | $186.21 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $630.96
| Professional | | $173.78 | $302.00 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $537.03
| Professional | | $371.54 | $371.54 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $269.15 / $588.84
| Professional | | $128.82 | $269.15 | $588.84 |