- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,513.56 / $2,454.71
| Facility | | $229.09 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $177.83 / $251.19
| Professional | | $158.49 | $177.83 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $11,481.54
| Facility | | $8,317.64 | $8,317.64 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $218.78
| Professional | | $162.18 | $162.18 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $616.60
| Professional | | $213.80 | $302.00 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $14,454.40
| Facility | | $2,089.30 | $5,495.41 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $346.74
| Professional | | $151.36 | $223.87 | $346.74 |