- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,981.07 / $7,413.10
| Facility | | $1,584.89 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $588.84 / $1,380.38
| Professional | | $281.84 | $588.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $2,570.40
| Professional | | $691.83 | $1,258.93 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,691.53 / $6,309.57
| Facility | | $426.58 | $2,691.53 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,348.96 / $2,818.38
| Professional | | $616.60 | $1,348.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $3,162.28
| Professional | | $1,122.02 | $1,778.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $812.83 / $1,995.26
| Facility | | $354.81 | $812.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $602.56 / $1,348.96
| Professional | | $60.26 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,479.11 / $2,691.53
| Professional | | $512.86 | $1,479.11 | $2,691.53 |