- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.12 / $4,443.50 / $8,572.13
| Facility | | $1,132.12 | $4,443.50 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.16 / $1,093.89 / $1,395.28
| Professional | | $884.16 | $1,093.89 | $1,395.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,271.00 / $19,794.66 / $48,414.52
| Facility | | $9,271.00 | $19,794.66 | $48,414.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.65 / $1,373.03 / $2,438.33
| Professional | | $1,191.65 | $1,373.03 | $2,438.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $1,130.42 / $1,260.85
| Facility | | $950.00 | $1,130.42 | $1,260.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.23 / $872.81 / $1,770.89
| Professional | | $705.23 | $872.81 | $1,770.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.43 / $1,552.15 / $2,421.42
| Professional | | $972.43 | $1,552.15 | $2,421.42 |