- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,570.88 / $11,220.18
| Facility | | $1,071.52 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $933.25 / $2,137.96
| Professional | | $851.14 | $933.25 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,220.18 / $22,908.68
| Facility | | $4,073.80 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $2,344.23
| Professional | | $870.96 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,691.53 / $7,585.78
| Facility | | $323.59 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $3,019.95
| Professional | | $912.01 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,137.96
| Professional | | $812.83 | $1,148.15 | $2,137.96 |