- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,344.23 / $4,365.16
| Facility | | $229.09 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $616.60 / $3,981.07
| Professional | | $218.78 | $616.60 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $5,754.40
| Professional | | $478.63 | $602.56 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,691.53 / $5,370.32
| Facility | | $302.00 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,570.88 / $14,454.40
| Professional | | $2,089.30 | $4,570.88 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $524.81 / $5,623.41
| Professional | | $467.74 | $524.81 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $3,090.30 / $4,365.16
| Professional | | $354.81 | $3,090.30 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $616.60 / $6,606.93
| Professional | | $288.40 | $616.60 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $4,677.35
| Professional | | $426.58 | $524.81 | $4,677.35 |