- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,888.44 / $10,964.78
| Facility | | $2,570.40 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $741.31
| Professional | | $263.03 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,096.48
| Professional | | $346.74 | $512.86 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $741.31
| Professional | | $426.58 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $977.24 / $1,548.82
| Facility | | $616.60 | $977.24 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $436.52 / $870.96
| Professional | | $257.04 | $436.52 | $870.96 |
- 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
- $257.04 / $380.19 / $691.83
| Professional | | $257.04 | $380.19 | $691.83 |