- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,760.83 / $12,882.50
| Facility | | $1,096.48 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,479.11
| Professional | | $549.54 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,148.15 / $1,445.44
| Professional | | $549.54 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $812.83 / $1,862.09
| Professional | | $478.63 | $812.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $977.24
| Professional | | $446.68 | $758.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,621.81
| Professional | | $512.86 | $676.08 | $1,621.81 |