- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $8,511.38
| Facility | | $2,570.40 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $645.65
| Professional | | $257.04 | $338.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $13,803.84 / $16,595.87
| Facility | | $7,079.46 | $13,803.84 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $549.54 / $724.44
| Professional | | $263.03 | $549.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $724.44
| Professional | | $323.59 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $489.78
| Professional | | $457.09 | $457.09 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $812.83
| Professional | | $263.03 | $371.54 | $812.83 |