- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.81 / $10,175.36 / $13,413.92
| Facility | | $1,082.81 | $10,175.36 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $408.76 / $1,979.59
| Professional | | $282.58 | $408.76 | $1,979.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.19 / $546.13 / $1,206.69
| Professional | | $341.19 | $546.13 | $1,206.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.66 / $1,473.74 / $2,771.43
| Facility | | $339.66 | $1,473.74 | $2,771.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.27 / $1,231.20 / $2,461.19
| Professional | | $730.27 | $1,231.20 | $2,461.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.56 / $1,559.25 / $2,330.10
| Professional | | $875.56 | $1,559.25 | $2,330.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.66 / $1,473.74 / $2,771.43
| Facility | | $339.66 | $1,473.74 | $2,771.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.77 / $1,215.00 / $2,206.00
| Professional | | $452.77 | $1,215.00 | $2,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.07 / $1,012.13 / $2,662.79
| Professional | | $494.07 | $1,012.13 | $2,662.79 |