- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $11,220.18 / $18,197.01
| Facility | | $2,344.23 | $11,220.18 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $794.33 / $912.01
| Professional | | $380.19 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $616.60 / $891.25
| Facility | | $575.44 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $616.60 / $912.01
| Professional | | $245.47 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,584.89 / $3,548.13
| Professional | | $1,479.11 | $1,584.89 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $616.60 / $891.25
| Facility | | $575.44 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $4,897.79
| Professional | | $1,258.93 | $2,137.96 | $4,897.79 |