- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.91 / $2,744.08 / $11,200.50
| Facility | | $1,909.91 | $2,744.08 | $11,200.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.07 / $819.36 / $2,195.27
| Professional | | $284.07 | $819.36 | $2,195.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.57 / $1,126.01 / $2,004.08
| Professional | | $763.57 | $1,126.01 | $2,004.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.63 / $1,527.93 / $3,073.38
| Facility | | $350.63 | $1,527.93 | $3,073.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.18 / $1,351.77 / $2,716.35
| Professional | | $764.18 | $1,351.77 | $2,716.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.25 / $1,769.30 / $2,722.00
| Professional | | $1,181.25 | $1,769.30 | $2,722.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.41 / $1,680.72 / $3,073.38
| Facility | | $392.41 | $1,680.72 | $3,073.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.50 / $1,698.75 / $2,653.95
| Professional | | $671.50 | $1,698.75 | $2,653.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.74 / $2,096.05 / $2,635.03
| Professional | | $1,197.74 | $2,096.05 | $2,635.03 |