- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,388.44 / $11,481.54
| Facility | | $1,202.26 | $3,388.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $2,137.96
| Professional | | $724.44 | $933.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $2,187.76
| Professional | | $707.95 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,089.30
| Professional | | $933.25 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $1,737.80
| Facility | | $851.14 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $1,621.81 / $2,187.76
| Professional | | $6.03 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $10,471.29
| Facility | | $2,398.83 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $1,995.26
| Professional | | $794.33 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $7,585.78 / $7,585.78
| Facility | | $56.23 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $7,244.36
| Professional | | $6,456.54 | $6,456.54 | $7,244.36 |