- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,888.44 / $10,964.78
| Facility | | $2,570.40 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $295.12 / $812.83
| Professional | | $229.09 | $295.12 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $954.99
| Professional | | $245.47 | $380.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $602.56
| Professional | | $288.40 | $436.52 | $602.56 |
- 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
- $229.09 / $354.81 / $1,096.48
| Professional | | $229.09 | $354.81 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $724.44
| Professional | | $199.53 | $316.23 | $724.44 |