- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,890.45 / $7,244.36
| Facility | | $275.42 | $3,890.45 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $616.60 / $1,288.25
| Professional | | $169.82 | $616.60 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $691.83 / $1,445.44
| Professional | | $213.80 | $691.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $537.03 / $1,698.24
| Professional | | $245.47 | $537.03 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,047.13 / $2,511.89
| Professional | | $213.80 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $741.31 / $758.58
| Professional | | $151.36 | $741.31 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,168.69 / $7,079.46
| Facility | | $1,479.11 | $4,168.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $977.24 / $1,819.70
| Professional | | $239.88 | $977.24 | $1,819.70 |