- 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
- $169.82 / $208.93 / $575.44
| Professional | | $169.82 | $208.93 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $630.96
| Professional | | $177.83 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $234.42 / $323.59
| Professional | | $194.98 | $234.42 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,230.27
| Facility | | $489.78 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $776.25
| Professional | | $158.49 | $257.04 | $776.25 |
- 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
- $144.54 / $208.93 / $524.81
| Professional | | $144.54 | $208.93 | $524.81 |