- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $2,238.72 / $8,317.64
| Facility | | $363.08 | $2,238.72 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $478.63 / $1,479.11
| Professional | | $147.91 | $478.63 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,786.30 / $12,882.50
| Facility | | $2,570.40 | $4,786.30 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $758.58 / $1,819.70
| Professional | | $162.18 | $758.58 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $2,041.74 / $5,888.44
| Facility | | $169.82 | $2,041.74 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $602.56 / $2,187.76
| Professional | | $181.97 | $602.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $660.69 / $1,698.24
| Professional | | $162.18 | $660.69 | $1,698.24 |