- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,888.44 / $8,511.38
| Facility | | $3,162.28 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $660.69
| Professional | | $512.86 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $79.43
| Professional | | $30.20 | $44.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,918.31 / $13,803.84
| Facility | | $5,888.44 | $6,918.31 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $1,023.29
| Professional | | $645.65 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $8,317.64
| Facility | | $2,137.96 | $5,128.61 | $8,317.64 |