- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $10,964.78
| Facility | | $2,290.87 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $741.31
| Professional | | $245.47 | $302.00 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $912.01
| Professional | | $263.03 | $380.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $575.44
| Professional | | $269.15 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,230.27
| Facility | | $501.19 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $1,122.02
| Professional | | $251.19 | $363.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $691.83
| Professional | | $213.80 | $309.03 | $691.83 |