- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,677.35 / $10,471.29
| Facility | | $1,318.26 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,659.59
| Professional | | $660.69 | $812.83 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $14,125.38 / $16,595.87
| Facility | | $7,079.46 | $14,125.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,348.96 / $1,659.59
| Professional | | $676.08 | $1,348.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $1,862.09
| Professional | | $831.76 | $1,148.15 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,230.27
| Professional | | $1,174.90 | $1,174.90 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,471.29 / $16,218.10
| Facility | | $6,456.54 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $2,041.74
| Professional | | $660.69 | $933.25 | $2,041.74 |