- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,162.28 / $4,570.88
| Facility | | $1,071.52 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $3,890.45
| Professional | | $645.65 | $933.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,621.81
| Professional | | $707.95 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,778.28
| Professional | | $32.36 | $33.11 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $1,778.28
| Professional | | $977.24 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,380.38 / $1,737.80
| Professional | | $630.96 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,778.28
| Professional | | $912.01 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,230.27
| Professional | | $616.60 | $776.25 | $1,230.27 |