- 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
- $190.55 / $891.25 / $3,235.94
| Professional | | $190.55 | $891.25 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,995.26 / $4,466.84
| Professional | | $316.23 | $1,995.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $707.95 / $4,570.88
| Professional | | $269.15 | $707.95 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,630.78
| Professional | | $3,162.28 | $3,162.28 | $3,630.78 |
- 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
- $218.78 / $1,148.15 / $5,128.61
| Professional | | $218.78 | $1,148.15 | $5,128.61 |