- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.08 / $1,681.96 / $4,040.41
| Facility | | $1,164.08 | $1,681.96 | $4,040.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.36 / $1,164.08 / $1,239.33
| Professional | | $938.36 | $1,164.08 | $1,239.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.90 / $2,598.17 / $4,381.93
| Facility | | $35.90 | $2,598.17 | $4,381.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.65 / $102.19 / $1,168.51
| Professional | | $78.65 | $102.19 | $1,168.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.81 / $4,909.10 / $10,161.84
| Facility | | $1,150.81 | $4,909.10 | $10,161.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.05 / $3,225.81 / $4,373.09
| Professional | | $2,036.05 | $3,225.81 | $4,373.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.42 / $1,062.29 / $3,107.02
| Professional | | $814.42 | $1,062.29 | $3,107.02 |