- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,760.83 / $18,197.01
| Facility | | $1,819.70 | $6,760.83 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $870.96 / $1,778.28
| Professional | | $707.95 | $870.96 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,630.78 / $20,892.96
| Facility | | $1,230.27 | $3,630.78 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $1,862.09
| Professional | | $794.33 | $1,258.93 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,412.54 / $2,511.89
| Facility | | $501.19 | $1,412.54 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $2,089.30
| Professional | | $870.96 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,202.26 / $4,466.84
| Professional | | $870.96 | $1,202.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $19,498.45
| Facility | | $2,454.71 | $7,943.28 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,862.09
| Professional | | $707.95 | $1,071.52 | $1,862.09 |