- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $3,467.37
| Facility | | $933.25 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $3,801.89
| Professional | | $912.01 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $17,378.01
| Facility | | $3,388.44 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $2,754.23
| Professional | | $1,122.02 | $1,584.89 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,388.44 / $9,332.54
| Facility | | $34.67 | $3,388.44 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $3,548.13
| Professional | | $1,071.52 | $1,659.59 | $3,548.13 |
- 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
- $977.24 / $1,348.96 / $2,344.23
| Professional | | $977.24 | $1,348.96 | $2,344.23 |