- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,981.07 / $10,715.19
| Facility | | $407.38 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $588.84
| Professional | | $199.53 | $302.00 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,365.16 / $10,232.93
| Facility | | $1,659.59 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $616.60
| Professional | | $208.93 | $302.00 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $501.19 / $2,344.23
| Facility | | $218.78 | $501.19 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $363.08 / $851.14
| Professional | | $204.17 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $302.00 / $549.54
| Professional | | $186.21 | $302.00 | $549.54 |