- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,897.79 / $8,511.38
| Facility | | $1,202.26 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $426.58 / $1,380.38
| Professional | | $218.78 | $426.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $467.74
| Professional | | $245.47 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $416.87 / $676.08
| Professional | | $223.87 | $416.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $389.05 / $389.05
| Professional | | $371.54 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $7,943.28
| Facility | | $4,365.16 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $562.34
| Professional | | $218.78 | $316.23 | $562.34 |