- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $7,762.47
| Facility | | $2,089.30 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $870.96 / $2,344.23
| Professional | | $724.44 | $870.96 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $5,888.44
| Facility | | $1,230.27 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $707.95 / $2,041.74
| Professional | | $630.96 | $707.95 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,584.89
| Professional | | $724.44 | $954.99 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,148.15 / $5,011.87
| Facility | | $758.58 | $1,148.15 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $6,165.95
| Professional | | $691.83 | $912.01 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,162.28 / $5,370.32
| Facility | | $1,288.25 | $3,162.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,513.56
| Professional | | $676.08 | $831.76 | $1,513.56 |