- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $8,128.31
| Facility | | $2,884.03 | $5,128.61 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $2,238.72
| Professional | | $537.03 | $616.60 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $2,951.21
| Facility | | $660.69 | $660.69 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $2,137.96
| Professional | | $660.69 | $660.69 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,570.40 / $2,630.27
| Facility | | $2,454.71 | $2,570.40 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,819.70 / $3,162.28
| Facility | | $524.81 | $1,819.70 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,318.26 / $1,995.26
| Professional | | $398.11 | $1,318.26 | $1,995.26 |