- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,309.57 / $16,218.10
| Facility | | $1,318.26 | $6,309.57 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $1,819.70
| Professional | | $602.56 | $724.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,882.50 / $31,622.78
| Facility | | $6,165.95 | $12,882.50 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,862.09
| Professional | | $575.44 | $891.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $15,848.93 / $36,307.81
| Facility | | $2,187.76 | $15,848.93 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $2,089.30
| Professional | | $707.95 | $1,071.52 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $13,489.63 / $33,884.42
| Facility | | $3,981.07 | $13,489.63 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,584.89
| Professional | | $616.60 | $891.25 | $1,584.89 |