- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $4,570.88 / $11,481.54
| Facility | | $302.00 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $199.53 / $457.09
| Professional | | $165.96 | $199.53 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,456.54 / $12,589.25
| Facility | | $2,630.27 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $501.19
| Professional | | $186.21 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $457.09 / $1,258.93
| Facility | | $204.17 | $457.09 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $602.56
| Professional | | $186.21 | $288.40 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $416.87
| Professional | | $158.49 | $234.42 | $416.87 |