- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,677.35 / $8,511.38
| Facility | | $3,235.94 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $478.63
| Professional | | $281.84 | $354.81 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $11,748.98
| Facility | | $2,137.96 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $416.87 / $1,096.48
| Professional | | $213.80 | $416.87 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $707.95 / $1,258.93
| Professional | | $398.11 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $741.31
| Professional | | $288.40 | $478.63 | $741.31 |