- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,025.60 / $10,964.78
| Facility | | $3,548.13 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $933.25 / $13,489.63
| Professional | | $524.81 | $933.25 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $1,548.82
| Professional | | $398.11 | $630.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $7,762.47
| Facility | | $1,412.54 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $691.83 / $1,513.56
| Professional | | $389.05 | $691.83 | $1,513.56 |