- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $10,471.29
| Facility | | $1,380.38 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $2,041.74
| Professional | | $616.60 | $831.76 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $18,620.87
| Facility | | $8,709.64 | $16,982.44 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,380.38 / $1,778.28
| Professional | | $691.83 | $1,380.38 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $1,949.84
| Professional | | $794.33 | $1,148.15 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,445.44
| Professional | | $1,174.90 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,862.09
| Professional | | $676.08 | $977.24 | $1,862.09 |