- 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
- $158.49 / $194.98 / $630.96
| Professional | | $158.49 | $194.98 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $562.34
| Professional | | $147.91 | $234.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $245.47 / $363.08
| Professional | | $194.98 | $245.47 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,912.51 / $13,803.84
| Facility | | $5,623.41 | $8,912.51 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $218.78 / $416.87
| Professional | | $147.91 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,165.95 / $10,964.78
| Facility | | $2,884.03 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $363.08
| Professional | | $117.49 | $186.21 | $363.08 |