- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,248.07 / $9,549.93
| Facility | | $3,162.28 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $218.78 / $371.54
| Professional | | $194.98 | $218.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $16,595.87 / $19,952.62
| Facility | | $8,317.64 | $16,595.87 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $398.11 / $524.81
| Professional | | $181.97 | $398.11 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $512.86
| Professional | | $257.04 | $363.08 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $354.81
| Professional | | $331.13 | $331.13 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $478.63
| Professional | | $181.97 | $281.84 | $478.63 |