- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $9,772.37 / $16,595.87
| Facility | | $1,230.27 | $9,772.37 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $1,737.80
| Professional | | $323.59 | $426.58 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,318.26
| Professional | | $1,202.26 | $1,202.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $2,818.38
| Facility | | $407.38 | $549.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $2,818.38
| Professional | | $724.44 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $2,344.23
| Professional | | $1,202.26 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,737.80 / $2,754.23
| Facility | | $512.86 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $371.54 / $1,318.26
| Professional | | $60.26 | $371.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $2,630.27
| Professional | | $933.25 | $1,047.13 | $2,630.27 |