- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,041.74
| Facility | | $933.25 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $831.76 / $977.24
| Professional | | $630.96 | $831.76 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $6,606.93
| Facility | | $4,786.30 | $4,786.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $954.99
| Professional | | $724.44 | $724.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $1,318.26
| Professional | | $537.03 | $1,096.48 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,981.07 / $10,964.78
| Facility | | $1,548.82 | $3,981.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,348.96
| Professional | | $630.96 | $741.31 | $1,348.96 |