- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $9,772.37 / $14,125.38
| Facility | | $1,318.26 | $9,772.37 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $467.74 / $1,288.25
| Professional | | $269.15 | $467.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $1,995.26
| Professional | | $724.44 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $676.08 / $3,090.30
| Facility | | $323.59 | $676.08 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,174.90 / $2,187.76
| Professional | | $676.08 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,659.59 / $2,570.40
| Professional | | $1,047.13 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $2,041.74
| Facility | | $346.74 | $602.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $602.56 / $1,122.02
| Professional | | $60.26 | $602.56 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,513.56 / $2,398.83
| Professional | | $446.68 | $1,513.56 | $2,398.83 |