- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,235.94 / $7,762.47
| Facility | | $281.84 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $2,398.83 / $4,677.35
| Professional | | $158.49 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $11,481.54 / $23,988.33
| Facility | | $6,025.60 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $1,096.48 / $5,128.61
| Professional | | $208.93 | $1,096.48 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $436.52 / $5,495.41
| Professional | | $218.78 | $436.52 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $3,801.89 / $10,715.19
| Professional | | $208.93 | $3,801.89 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $2,630.27 / $2,754.23
| Professional | | $147.91 | $2,630.27 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,022.64 / $20,417.38
| Facility | | $8,511.38 | $12,022.64 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $3,235.94 / $6,456.54
| Professional | | $229.09 | $3,235.94 | $6,456.54 |