- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $7,413.10
| Facility | | $2,454.71 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $660.69
| Professional | | $194.98 | $269.15 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $12,022.64
| Facility | | $3,630.78 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $416.87 / $549.54
| Professional | | $181.97 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $549.54
| Professional | | $245.47 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $371.54
| Professional | | $338.84 | $338.84 | $371.54 |
- 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
- $199.53 / $275.42 / $616.60
| Professional | | $199.53 | $275.42 | $616.60 |