- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $10,471.29
| Facility | | $2,290.87 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $691.83 / $3,388.44
| Professional | | $199.53 | $691.83 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,862.09 / $5,888.44
| Professional | | $331.13 | $1,862.09 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $724.44 / $4,677.35
| Professional | | $281.84 | $724.44 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $4,365.16
| Professional | | $2,818.38 | $2,818.38 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,174.90 / $4,897.79
| Professional | | $229.09 | $1,174.90 | $4,897.79 |