- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.13 / $6,783.04 / $15,742.72
| Facility | | $1,196.13 | $6,783.04 | $15,742.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.50 / $838.47 / $1,670.21
| Professional | | $640.50 | $838.47 | $1,670.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.73 / $926.30 / $1,009.23
| Facility | | $833.73 | $926.30 | $1,009.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.22 / $897.10 / $897.10
| Professional | | $460.22 | $897.10 | $897.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.71 / $898.71 / $898.71
| Facility | | $898.71 | $898.71 | $898.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.73 / $1,098.33 / $2,109.54
| Professional | | $765.73 | $1,098.33 | $2,109.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,255.93 / $12,733.88 / $17,874.43
| Facility | | $9,255.93 | $12,733.88 | $17,874.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.11 / $1,121.73 / $1,771.30
| Professional | | $1,101.11 | $1,121.73 | $1,771.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.66 / $929.76 / $1,267.60
| Professional | | $591.66 | $929.76 | $1,267.60 |