- 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
- $338.84 / $537.03 / $1,862.09
| Professional | | $338.84 | $537.03 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,584.89
| Professional | | $1,174.90 | $1,174.90 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $2,691.53
| Facility | | $316.23 | $501.19 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,819.70
| Professional | | $812.83 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,513.56 / $2,754.23
| Professional | | $891.25 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $2,691.53
| Facility | | $316.23 | $537.03 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $676.08 / $1,548.82
| Professional | | $60.26 | $676.08 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,230.27 / $1,905.46
| Professional | | $630.96 | $1,230.27 | $1,905.46 |