- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,168.69 / $6,918.31
| Facility | | $1,348.96 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $269.15 / $302.00
| Professional | | $234.42 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $501.19
| Professional | | $208.93 | $275.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $6,606.93
| Facility | | $1,071.52 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $331.13 / $489.78
| Professional | | $257.04 | $331.13 | $489.78 |