- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,238.72 / $7,413.10
| Facility | | $338.84 | $2,238.72 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $288.40 / $1,174.90
| Professional | | $63.10 | $288.40 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,365.16 / $9,332.54
| Facility | | $1,513.56 | $4,365.16 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $575.44 / $1,318.26
| Professional | | $72.44 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $602.56 / $2,238.72
| Facility | | $91.20 | $602.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $275.42 / $1,318.26
| Professional | | $70.79 | $275.42 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,511.89 / $6,025.60
| Facility | | $660.69 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $436.52 / $1,148.15
| Professional | | $61.66 | $436.52 | $1,148.15 |