- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $10,715.19
| Facility | | $4,365.16 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $436.52 / $1,202.26
| Professional | | $371.54 | $436.52 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $645.65 / $1,548.82
| Professional | | $316.23 | $645.65 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $794.33
| Professional | | $446.68 | $602.56 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,471.29 / $16,595.87
| Facility | | $6,606.93 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $1,047.13
| Professional | | $346.74 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,413.10 / $15,135.61
| Facility | | $3,467.37 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $851.14
| Professional | | $234.42 | $407.38 | $851.14 |