- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,623.41 / $7,413.10
| Facility | | $3,162.28 | $5,623.41 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $616.60
| Professional | | $181.97 | $234.42 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,801.89 / $7,244.36
| Facility | | $1,230.27 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $275.42
| Professional | | $138.04 | $229.09 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $794.33
| Professional | | $416.87 | $537.03 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $8,511.38
| Facility | | $1,513.56 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $371.54 / $977.24
| Professional | | $239.88 | $371.54 | $977.24 |