- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,456.54 / $11,748.98
| Facility | | $1,096.48 | $6,456.54 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $389.05 / $954.99
| Professional | | $190.55 | $389.05 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $478.63 / $1,230.27
| Professional | | $218.78 | $478.63 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,096.48
| Professional | | $562.34 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,888.44 / $9,549.93
| Facility | | $3,981.07 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $478.63 / $1,023.29
| Professional | | $173.78 | $478.63 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $8,709.64
| Facility | | $2,570.40 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $389.05 / $933.25
| Professional | | $173.78 | $389.05 | $933.25 |