- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $7,079.46 / $14,125.38
| Facility | | $1,071.52 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $630.96 / $1,737.80
| Professional | | $346.74 | $630.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,513.56 / $2,691.53
| Professional | | $870.96 | $1,513.56 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $891.25 / $3,162.28
| Facility | | $354.81 | $891.25 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,584.89 / $2,951.21
| Professional | | $831.76 | $1,584.89 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,454.71 / $4,073.80
| Professional | | $1,412.54 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $851.14 / $2,884.03
| Facility | | $354.81 | $851.14 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $724.44 / $1,513.56
| Professional | | $60.26 | $724.44 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,778.28 / $3,311.31
| Professional | | $630.96 | $1,778.28 | $3,311.31 |