- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,677.35 / $10,964.78
| Facility | | $1,174.90 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $616.60
| Professional | | $363.08 | $524.81 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,481.54 / $23,988.33
| Facility | | $4,073.80 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $794.33 / $1,548.82
| Professional | | $524.81 | $794.33 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $912.01 / $10,964.78
| Facility | | $851.14 | $912.01 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,511.89 / $2,511.89
| Professional | | $758.58 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,677.35 / $11,220.18
| Facility | | $1,513.56 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,174.90
| Professional | | $446.68 | $645.65 | $1,174.90 |