- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,071.52 / $2,089.30
| Facility | | $346.74 | $1,071.52 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $912.01 / $1,737.80
| Professional | | $114.82 | $912.01 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $4,897.79
| Facility | | $3,548.13 | $3,548.13 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $165.96 / $1,584.89
| Professional | | $125.89 | $165.96 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $501.19 / $2,089.30
| Professional | | $158.49 | $501.19 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $8,128.31
| Facility | | $1,230.27 | $2,951.21 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $977.24 / $1,949.84
| Professional | | $147.91 | $977.24 | $1,949.84 |