- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,370.32 / $16,218.10
| Facility | | $1,071.52 | $5,370.32 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $933.25 / $1,905.46
| Professional | | $758.58 | $933.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,912.51 / $17,378.01
| Facility | | $3,548.13 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $2,089.30
| Professional | | $724.44 | $1,096.48 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,370.32 / $33,113.11
| Facility | | $933.25 | $5,370.32 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,288.25 / $2,691.53
| Professional | | $794.33 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $10,471.29
| Facility | | $851.14 | $3,235.94 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,047.13 / $1,905.46
| Professional | | $724.44 | $1,047.13 | $1,905.46 |