- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,137.96 / $7,762.47
| Facility | | $338.84 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $537.03 / $3,981.07
| Professional | | $234.42 | $537.03 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $741.31
| Facility | | $407.38 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $3,981.07
| Professional | | $281.84 | $501.19 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,162.28
| Professional | | $32.36 | $33.11 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $660.69 / $4,466.84
| Facility | | $239.88 | $660.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $562.34 / $4,265.80
| Professional | | $281.84 | $562.34 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,467.37 / $5,248.07
| Facility | | $562.34 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $562.34 / $4,677.35
| Professional | | $295.12 | $562.34 | $4,677.35 |