- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,888.44 / $10,964.78
| Facility | | $3,311.31 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $758.58 / $1,096.48
| Professional | | $295.12 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $501.19 / $977.24
| Professional | | $467.74 | $501.19 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $602.56 / $1,513.56
| Professional | | $363.08 | $602.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $7,762.47
| Facility | | $1,412.54 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,096.48
| Professional | | $346.74 | $512.86 | $1,096.48 |