- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,011.87 / $7,244.36
| Facility | | $2,884.03 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $512.86 / $1,737.80
| Professional | | $154.88 | $512.86 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,862.09
| Professional | | $588.84 | $588.84 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,467.37 / $5,754.40
| Facility | | $831.76 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,148.15 / $3,090.30
| Professional | | $346.74 | $1,148.15 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,071.52 / $3,311.31
| Professional | | $645.65 | $1,071.52 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,148.15 / $3,235.94
| Facility | | $295.12 | $1,148.15 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $229.09 / $1,862.09
| Professional | | $60.26 | $229.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,174.90 / $3,715.35
| Professional | | $416.87 | $1,174.90 | $3,715.35 |