- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,162.28 / $5,128.61
| Facility | | $1,096.48 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $831.76 / $2,041.74
| Professional | | $50.12 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $616.60 / $1,621.81
| Professional | | $61.66 | $616.60 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $588.84
| Professional | | $32.36 | $33.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $141.25 / $1,949.84
| Professional | | $72.44 | $141.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $812.83 / $2,137.96
| Professional | | $53.70 | $812.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $1,096.48 / $1,584.89
| Professional | | $69.18 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $776.25 / $1,659.59
| Professional | | $51.29 | $776.25 | $1,659.59 |