- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,754.23 / $4,073.80
| Facility | | $380.19 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $812.83
| Professional | | $275.42 | $363.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,071.52 / $7,943.28
| Professional | | $263.03 | $1,071.52 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $660.69 / $1,023.29
| Professional | | $338.84 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $676.08
| Professional | | $316.23 | $371.54 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $26,915.35
| Facility | | $3,311.31 | $16,218.10 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $457.09 / $794.33
| Professional | | $257.04 | $457.09 | $794.33 |