- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.37 / $7,010.33 / $21,490.56
| Facility | | $676.37 | $7,010.33 | $21,490.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.98 / $688.82 / $1,232.19
| Professional | | $588.98 | $688.82 | $1,232.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.65 / $767.32 / $928.89
| Facility | | $631.65 | $767.32 | $928.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.39 / $1,391.87 / $1,637.51
| Professional | | $720.39 | $1,391.87 | $1,637.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.17 / $1,120.17 / $1,120.17
| Facility | | $1,120.17 | $1,120.17 | $1,120.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.41 / $864.93 / $1,989.76
| Professional | | $616.41 | $864.93 | $1,989.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,262.48 / $4,006.41 / $24,882.10
| Facility | | $3,262.48 | $4,006.41 | $24,882.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.71 / $1,005.71 / $1,032.70
| Professional | | $1,005.71 | $1,005.71 | $1,032.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.69 / $850.55 / $1,181.66
| Professional | | $591.69 | $850.55 | $1,181.66 |