- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $5,128.61 / $7,762.47
| Facility | | $251.19 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $257.04 / $776.25
| Professional | | $245.47 | $257.04 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $4,073.80 / $8,128.31
| Professional | | $275.42 | $4,073.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $316.23 / $676.08
| Professional | | $245.47 | $316.23 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $229.09 / $524.81
| Professional | | $218.78 | $229.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,454.40 / $26,302.68
| Facility | | $2,344.23 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $575.44
| Professional | | $213.80 | $302.00 | $575.44 |