- 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
- $269.15 / $346.74 / $436.52
| Professional | | $269.15 | $346.74 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,760.83 / $16,218.10
| Facility | | $2,290.87 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $562.34
| Professional | | $309.03 | $524.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $707.95
| Professional | | $371.54 | $489.78 | $707.95 |
- 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
- $363.08 / $524.81 / $933.25
| Professional | | $363.08 | $524.81 | $933.25 |