- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,918.31 / $10,964.78
| Facility | | $4,168.69 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $501.19
| Professional | | $147.91 | $208.93 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $588.84
| Professional | | $162.18 | $257.04 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $426.58
| Professional | | $204.17 | $309.03 | $426.58 |
- 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
- $128.82 / $245.47 / $602.56
| Professional | | $128.82 | $245.47 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,585.78 / $15,135.61
| Facility | | $3,630.78 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $478.63
| Professional | | $131.83 | $208.93 | $478.63 |