- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $10,964.78
| Facility | | $2,570.40 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $407.38 / $1,202.26
| Professional | | $208.93 | $407.38 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $501.19 / $1,202.26
| Professional | | $234.42 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $933.25
| Professional | | $426.58 | $676.08 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,884.03 / $4,570.88
| Facility | | $1,819.70 | $2,884.03 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $478.63 / $1,380.38
| Professional | | $181.97 | $478.63 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,715.35 / $7,762.47
| Facility | | $1,862.09 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $389.05 / $851.14
| Professional | | $169.82 | $389.05 | $851.14 |