- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $8,709.64
| Facility | | $1,288.25 | $2,398.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,148.15 / $2,570.40
| Professional | | $933.25 | $1,148.15 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $2,691.53
| Professional | | $1,230.27 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,548.82 / $2,511.89
| Professional | | $1,122.02 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $2,290.87
| Facility | | $977.24 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $1,862.09 / $2,454.71
| Professional | | $3.02 | $1,862.09 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $14,454.40
| Facility | | $3,548.13 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $2,290.87
| Professional | | $933.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $45,708.82
| Facility | | $26,915.35 | $26,915.35 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |