- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,370.32 / $7,413.10
| Facility | | $398.11 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $537.03
| Professional | | $208.93 | $316.23 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,290.87 / $3,548.13
| Facility | | $870.96 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $323.59 / $575.44
| Professional | | $223.87 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $323.59 / $707.95
| Professional | | $204.17 | $323.59 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $457.09 / $575.44
| Professional | | $251.19 | $457.09 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,513.56 / $2,511.89
| Facility | | $309.03 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $724.44
| Professional | | $245.47 | $380.19 | $724.44 |