- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,495.41 / $10,715.19
| Facility | | $3,311.31 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $380.19 / $1,202.26
| Professional | | $331.13 | $380.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $1,202.26
| Professional | | $331.13 | $549.54 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $588.84
| Professional | | $331.13 | $446.68 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $17,378.01
| Facility | | $7,244.36 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $851.14
| Professional | | $288.40 | $398.11 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,801.89 / $7,943.28
| Facility | | $1,862.09 | $3,801.89 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $776.25
| Professional | | $234.42 | $354.81 | $776.25 |