- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $9,549.93
| Facility | | $4,570.88 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $602.56
| Professional | | $186.21 | $245.47 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $165.96 / $602.56
| Professional | | $63.10 | $165.96 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $1,258.93
| Professional | | $251.19 | $416.87 | $1,258.93 |