- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,918.31 / $10,964.78
| Facility | | $4,168.69 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $537.03
| Professional | | $190.55 | $295.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $316.23 / $741.31
| Professional | | $169.82 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $512.86
| Professional | | $275.42 | $380.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,244.36 / $11,748.98
| Facility | | $4,570.88 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $602.56
| Professional | | $162.18 | $323.59 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $10,964.78
| Facility | | $2,884.03 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $281.84 / $537.03
| Professional | | $158.49 | $281.84 | $537.03 |