- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,090.30 / $6,309.57
| Facility | | $1,412.54 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $537.03 / $3,981.07
| Professional | | $87.10 | $537.03 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,659.59 / $3,019.95
| Facility | | $630.96 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $630.96
| Professional | | $295.12 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,230.27 / $2,041.74
| Facility | | $281.84 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $954.99 / $2,187.76
| Facility | | $199.53 | $954.99 | $2,187.76 |