- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,897.79 / $16,595.87
| Facility | | $549.54 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $1,412.54 / $2,454.71
| Professional | | $173.78 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $309.03 / $2,137.96
| Professional | | $165.96 | $309.03 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $537.03 / $3,311.31
| Professional | | $234.42 | $537.03 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $1,412.54 / $3,890.45
| Facility | | $194.98 | $1,412.54 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,202.26 / $3,548.13
| Facility | | $380.19 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $1,288.25 / $2,951.21
| Professional | | $177.83 | $1,288.25 | $2,951.21 |