- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,011.87 / $7,079.46
| Facility | | $3,090.30 | $5,011.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $446.68
| Professional | | $131.83 | $208.93 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $213.80 / $323.59
| Professional | | $128.82 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $354.81
| Professional | | $162.18 | $239.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $251.19 / $389.05
| Professional | | $151.36 | $251.19 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,011.87 / $7,079.46
| Facility | | $3,090.30 | $5,011.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $407.38
| Professional | | $128.82 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $234.42 / $389.05
| Professional | | $154.88 | $234.42 | $389.05 |