- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,897.79 / $8,511.38
| Facility | | $2,691.53 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,479.11
| Professional | | $446.68 | $575.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $11,748.98 / $13,803.84
| Facility | | $6,309.57 | $11,748.98 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,047.13 / $1,318.26
| Professional | | $446.68 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,318.26
| Professional | | $562.34 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $851.14
| Professional | | $812.83 | $812.83 | $851.14 |
- 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
- $478.63 / $707.95 / $1,445.44
| Professional | | $478.63 | $707.95 | $1,445.44 |