- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.33 / $1,136.33 / $1,679.80
| Facility | | $1,136.33 | $1,136.33 | $1,679.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.78 / $1,393.98 / $1,679.80
| Professional | | $731.78 | $1,393.98 | $1,679.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.46 / $1,242.75 / $1,910.52
| Professional | | $1,114.46 | $1,242.75 | $1,910.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.58 / $415.25 / $4,008.14
| Facility | | $233.58 | $415.25 | $4,008.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.52 / $428.22 / $5,080.30
| Professional | | $259.52 | $428.22 | $5,080.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.60 / $1,436.52 / $2,613.40
| Facility | | $192.60 | $1,436.52 | $2,613.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.04 / $1,221.04 / $10,257.35
| Professional | | $1,221.04 | $1,221.04 | $10,257.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.61 / $227.04 / $2,270.41
| Professional | | $159.61 | $227.04 | $2,270.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.29 / $1,114.46 / $1,578.82
| Professional | | $728.29 | $1,114.46 | $1,578.82 |