- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $9,772.37
| Facility | | $1,479.11 | $1,819.70 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $380.19 / $1,122.02
| Professional | | $316.23 | $380.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $724.44 / $1,047.13
| Professional | | $316.23 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,202.26
| Professional | | $380.19 | $676.08 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $977.24
| Professional | | $354.81 | $575.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $1,174.90
| Professional | | $380.19 | $602.56 | $1,174.90 |