- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,471.29
| Facility | | $2,089.30 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $630.96
| Professional | | $181.97 | $257.04 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,884.03 / $6,760.83
| Facility | | $588.84 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $4,677.35
| Professional | | $234.42 | $309.03 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,884.03 / $6,309.57
| Facility | | $1,659.59 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $478.63
| Professional | | $234.42 | $309.03 | $478.63 |