- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,235.94 / $11,748.98
| Facility | | $812.83 | $3,235.94 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $2,691.53 / $8,128.31
| Professional | | $524.81 | $2,691.53 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,332.54 / $12,882.50
| Facility | | $7,244.36 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $6,918.31 / $8,317.64
| Professional | | $354.81 | $6,918.31 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,479.11 / $10,964.78
| Facility | | $891.25 | $1,479.11 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,479.11 / $10,964.78
| Professional | | $891.25 | $1,479.11 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,148.15 / $2,398.83
| Facility | | $218.78 | $1,148.15 | $2,398.83 |