- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,466.84 / $10,964.78
| Facility | | $1,174.90 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $954.99 / $2,089.30
| Professional | | $812.83 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $17,782.79
| Facility | | $3,548.13 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $2,187.76
| Professional | | $794.33 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,187.76 / $6,606.93
| Facility | | $645.65 | $2,187.76 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,818.38
| Professional | | $870.96 | $1,318.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,995.26
| Professional | | $758.58 | $1,071.52 | $1,995.26 |