- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,981.07 / $3,981.07
| Facility | | $3,715.35 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $1,621.81
| Professional | | $213.80 | $281.84 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,772.37 / $10,964.78
| Facility | | $8,511.38 | $9,772.37 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $245.47 / $354.81
| Professional | | $218.78 | $245.47 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $407.38 / $776.25
| Professional | | $194.98 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,238.72 / $6,606.93
| Facility | | $575.44 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $436.52
| Professional | | $181.97 | $251.19 | $436.52 |