- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,888.44 / $10,964.78
| Facility | | $3,467.37 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $363.08
| Professional | | $194.98 | $295.12 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,754.23 / $3,630.78
| Facility | | $549.54 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,309.57 / $9,549.93
| Facility | | $3,890.45 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $676.08
| Professional | | $245.47 | $354.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,128.61 / $8,511.38
| Facility | | $2,089.30 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $316.23 / $645.65
| Professional | | $229.09 | $316.23 | $645.65 |