- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,570.88 / $8,511.38
| Facility | | $389.05 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $177.83 / $338.84
| Professional | | $79.43 | $177.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $11,748.98
| Facility | | $2,137.96 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $229.09 / $524.81
| Professional | | $112.20 | $229.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $1,000.00
| Facility | | $263.03 | $263.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $234.42 / $501.19
| Professional | | $97.72 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $407.38
| Professional | | $239.88 | $309.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,248.07 / $8,912.51
| Facility | | $912.01 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $177.83 / $407.38
| Professional | | $79.43 | $177.83 | $407.38 |