- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $12,022.64 / $16,595.87
| Facility | | $1,479.11 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $2,754.23
| Professional | | $489.78 | $630.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $3,801.89
| Facility | | $575.44 | $724.44 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $3,311.31
| Professional | | $1,122.02 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,949.84 / $2,754.23
| Professional | | $1,778.28 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,754.23 / $3,890.45
| Facility | | $724.44 | $2,754.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $467.74 / $1,698.24
| Professional | | $60.26 | $467.74 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $3,090.30
| Professional | | $758.58 | $1,348.96 | $3,090.30 |