- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $371.54 / $501.19
| Professional | | $323.59 | $371.54 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $8,128.31 / $21,877.62
| Facility | | $338.84 | $8,128.31 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $3,162.28
| Professional | | $275.42 | $389.05 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $11,748.98 / $20,892.96
| Facility | | $3,467.37 | $11,748.98 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $524.81
| Professional | | $263.03 | $363.08 | $524.81 |