- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,754.23 / $11,481.54
| Facility | | $1,122.02 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $371.54 / $794.33
| Professional | | $107.15 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,412.54 / $2,630.27
| Facility | | $1,288.25 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $269.15 / $1,122.02
| Professional | | $104.71 | $269.15 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $380.19 / $2,041.74
| Professional | | $162.18 | $380.19 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $660.69 / $1,513.56
| Professional | | $128.82 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $660.69 / $1,949.84
| Professional | | $173.78 | $660.69 | $1,949.84 |