- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,073.80 / $10,715.19
| Facility | | $870.96 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,023.29 / $1,949.84
| Professional | | $338.84 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,011.87 / $13,803.84
| Facility | | $2,041.74 | $5,011.87 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,071.52 / $2,398.83
| Professional | | $346.74 | $1,071.52 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,265.80 / $17,378.01
| Facility | | $562.34 | $4,265.80 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,071.52 / $3,019.95
| Professional | | $363.08 | $1,071.52 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,511.38 / $18,620.87
| Facility | | $3,019.95 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,023.29 / $2,344.23
| Professional | | $331.13 | $1,023.29 | $2,344.23 |