- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,235.94 / $8,709.64
| Facility | | $575.44 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $288.40 / $1,047.13
| Professional | | $91.20 | $288.40 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,471.29
| Facility | | $2,238.72 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $457.09 / $1,148.15
| Professional | | $89.13 | $457.09 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $630.96 / $3,019.95
| Facility | | $97.72 | $630.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $331.13 / $1,348.96
| Professional | | $97.72 | $331.13 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,818.38 / $6,309.57
| Facility | | $891.25 | $2,818.38 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $407.38 / $1,071.52
| Professional | | $89.13 | $407.38 | $1,071.52 |