- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,888.44 / $10,964.78
| Facility | | $2,754.23 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $229.09 / $602.56
| Professional | | $190.55 | $229.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $602.56
| Professional | | $169.82 | $275.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $436.52
| Professional | | $229.09 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,951.21 / $4,677.35
| Facility | | $1,905.46 | $2,951.21 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $489.78
| Professional | | $173.78 | $245.47 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,548.13 / $7,762.47
| Facility | | $1,778.28 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $218.78 / $436.52
| Professional | | $131.83 | $218.78 | $436.52 |