- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $4,570.88 / $8,511.38
| Facility | | $501.19 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $234.42 / $467.74
| Professional | | $97.72 | $234.42 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $213.80 / $512.86
| Professional | | $158.49 | $213.80 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $223.87 / $588.84
| Professional | | $89.13 | $223.87 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $426.58
| Professional | | $177.83 | $302.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $218.78 / $407.38
| Professional | | $91.20 | $218.78 | $407.38 |