- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $7,079.46 / $14,125.38
| Facility | | $1,148.15 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $1,148.15
| Professional | | $363.08 | $549.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $2,290.87
| Professional | | $954.99 | $1,288.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $977.24 / $2,691.53
| Facility | | $407.38 | $977.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,479.11 / $2,570.40
| Professional | | $891.25 | $1,479.11 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $2,951.21
| Professional | | $1,380.38 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $2,630.27
| Facility | | $426.58 | $741.31 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $724.44 / $1,288.25
| Professional | | $60.26 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,778.28 / $2,951.21
| Professional | | $501.19 | $1,778.28 | $2,951.21 |