- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,888.44 / $10,964.78
| Facility | | $3,311.31 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $891.25
| Professional | | $245.47 | $331.13 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $446.68 / $954.99
| Professional | | $234.42 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $524.81
| Professional | | $295.12 | $398.11 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,786.30 / $7,585.78
| Facility | | $3,090.30 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $758.58
| Professional | | $239.88 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $8,511.38
| Facility | | $2,570.40 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $281.84 / $602.56
| Professional | | $208.93 | $281.84 | $602.56 |