- 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
- $144.54 / $190.55 / $234.42
| Professional | | $144.54 | $190.55 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,019.95 / $6,918.31
| Facility | | $1,071.52 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $1,348.96
| Professional | | $169.82 | $275.42 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $239.88 / $2,137.96
| Professional | | $128.82 | $239.88 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,090.30 / $5,370.32
| Facility | | $562.34 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $489.78
| Professional | | $177.83 | $275.42 | $489.78 |