- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $8,511.38
| Facility | | $2,290.87 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $1,096.48
| Professional | | $436.52 | $537.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $13,182.57 / $16,595.87
| Facility | | $3,981.07 | $13,182.57 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $870.96 / $1,096.48
| Professional | | $416.87 | $870.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,230.27
| Professional | | $549.54 | $758.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $812.83
| Professional | | $776.25 | $776.25 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $1,380.38
| Professional | | $436.52 | $616.60 | $1,380.38 |