- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,569.43 / $5,084.91 / $13,413.92
| Facility | | $1,569.43 | $5,084.91 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.07 / $594.08 / $2,869.24
| Professional | | $63.07 | $594.08 | $2,869.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.45 / $483.25 / $1,774.33
| Professional | | $81.45 | $483.25 | $1,774.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.74 / $523.78 / $4,016.94
| Facility | | $83.74 | $523.78 | $4,016.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.74 / $625.10 / $3,500.20
| Professional | | $186.74 | $625.10 | $3,500.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.60 / $523.79 / $3,788.00
| Professional | | $231.60 | $523.79 | $3,788.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.74 / $523.78 / $4,016.94
| Facility | | $83.74 | $523.78 | $4,016.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.34 / $625.10 / $3,693.30
| Professional | | $141.34 | $625.10 | $3,693.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.37 / $1,556.88 / $4,268.26
| Professional | | $614.37 | $1,556.88 | $4,268.26 |