- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,290.87 / $4,365.16
| Facility | | $676.08 | $2,290.87 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $676.08 / $741.31
| Professional | | $223.87 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,023.29 / $1,412.54
| Facility | | $380.19 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $891.25 / $5,495.41
| Professional | | $331.13 | $891.25 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $977.24 / $1,659.59
| Professional | | $501.19 | $977.24 | $1,659.59 |