- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,897.79 / $11,220.18
| Facility | | $831.76 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $1,230.27
| Professional | | $398.11 | $562.34 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $19,054.61
| Facility | | $3,715.35 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $758.58
| Professional | | $316.23 | $467.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $446.68 / $501.19
| Facility | | $398.11 | $446.68 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,511.89
| Facility | | $2,137.96 | $2,137.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $977.24
| Professional | | $436.52 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $933.25
| Professional | | $380.19 | $537.03 | $933.25 |