- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $7,762.47
| Facility | | $2,089.30 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $2,511.89
| Professional | | $512.86 | $812.83 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,445.44 / $2,691.53
| Facility | | $549.54 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,412.54
| Professional | | $691.83 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $1,819.70
| Professional | | $1,122.02 | $1,380.38 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $5,495.41
| Facility | | $724.44 | $1,348.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $741.31 / $6,456.54
| Professional | | $295.12 | $741.31 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,168.69 / $7,244.36
| Facility | | $1,412.54 | $4,168.69 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $707.95 / $1,174.90
| Professional | | $275.42 | $707.95 | $1,174.90 |