- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,677.35 / $7,943.28
| Facility | | $1,380.38 | $4,677.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $138.04 / $371.54
| Professional | | $72.44 | $138.04 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $141.25 / $213.80
| Professional | | $89.13 | $141.25 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $323.59
| Professional | | $102.33 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $186.21 / $186.21
| Professional | | $181.97 | $186.21 | $186.21 |
- 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
- $85.11 / $151.36 / $275.42
| Professional | | $85.11 | $151.36 | $275.42 |