- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $9,549.93 / $16,595.87
| Facility | | $1,348.96 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $562.34 / $2,187.76
| Professional | | $489.78 | $562.34 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $3,019.95
| Facility | | $524.81 | $660.69 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $3,090.30
| Professional | | $1,096.48 | $1,412.54 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $2,630.27
| Professional | | $1,949.84 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,187.76 / $3,090.30
| Facility | | $660.69 | $2,187.76 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $416.87 / $1,445.44
| Professional | | $60.26 | $416.87 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,148.15 / $2,884.03
| Professional | | $1,096.48 | $1,148.15 | $2,884.03 |