- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,862.09 / $3,162.28
| Facility | | $316.23 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $707.95
| Professional | | $131.83 | $208.93 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $1,258.93 / $4,073.80
| Professional | | $177.83 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $363.08 / $1,584.89
| Professional | | $128.82 | $363.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $575.44 / $1,202.26
| Professional | | $537.03 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,760.83 / $26,302.68
| Facility | | $1,023.29 | $6,760.83 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $354.81 / $1,318.26
| Professional | | $120.23 | $354.81 | $1,318.26 |