- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,918.31 / $10,964.78
| Facility | | $4,466.84 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $4,168.69
| Professional | | $173.78 | $245.47 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $11,748.98 / $18,620.87
| Facility | | $7,585.78 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $812.83
| Professional | | $190.55 | $257.04 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,413.10 / $15,135.61
| Facility | | $3,467.37 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $691.83
| Professional | | $223.87 | $389.05 | $691.83 |