- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,897.79 / $6,918.31
| Facility | | $4,786.30 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $288.40 / $371.54
| Professional | | $251.19 | $288.40 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,772.37 / $18,620.87
| Facility | | $4,073.80 | $9,772.37 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,897.79 / $6,918.31
| Facility | | $4,786.30 | $4,897.79 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $288.40 / $346.74
| Professional | | $263.03 | $288.40 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,585.78 / $10,471.29
| Facility | | $4,073.80 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $346.74 / $457.09
| Professional | | $281.84 | $346.74 | $457.09 |