- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $10,715.19
| Facility | | $2,570.40 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $426.58 / $1,380.38
| Professional | | $354.81 | $426.58 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $1,348.96
| Professional | | $380.19 | $562.34 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $831.76
| Professional | | $407.38 | $602.56 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,128.61 / $8,128.31
| Facility | | $3,235.94 | $5,128.61 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $1,621.81
| Professional | | $363.08 | $524.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,019.95 / $7,762.47
| Facility | | $1,412.54 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $1,023.29
| Professional | | $309.03 | $446.68 | $1,023.29 |