- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,888.44 / $10,715.19
| Facility | | $2,754.23 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $1,174.90
| Professional | | $234.42 | $371.54 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $501.19 / $1,148.15
| Professional | | $257.04 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $489.78 / $776.25
| Professional | | $426.58 | $489.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,120.11 / $14,454.40
| Facility | | $5,888.44 | $9,120.11 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $426.58 / $851.14
| Professional | | $204.17 | $426.58 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,248.07 / $9,120.11
| Facility | | $2,570.40 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $281.84 / $691.83
| Professional | | $144.54 | $281.84 | $691.83 |