- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,981.07 / $8,912.51
| Facility | | $1,380.38 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $302.00 / $446.68
| Professional | | $47.86 | $302.00 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $8,128.31 / $20,892.96
| Facility | | $131.83 | $8,128.31 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $63.10 / $2,754.23
| Professional | | $43.65 | $63.10 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $11,748.98 / $20,417.38
| Facility | | $3,467.37 | $11,748.98 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $57.54 / $85.11
| Professional | | $41.69 | $57.54 | $85.11 |