- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,606.93
| Facility | | $1,445.44 | $3,090.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $2,238.72 / $14,791.08
| Professional | | $426.58 | $2,238.72 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,318.26 / $1,995.26
| Facility | | $416.87 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $758.58 / $2,137.96
| Professional | | $676.08 | $758.58 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,317.64 / $10,964.78
| Facility | | $6,025.60 | $8,317.64 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,079.46 / $10,964.78
| Facility | | $5,011.87 | $7,079.46 | $10,964.78 |