- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $7,943.28 / $16,595.87
| Facility | | $1,380.38 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,258.93 / $1,949.84
| Professional | | $1,047.13 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,148.15 / $1,513.56
| Professional | | $1,071.52 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,995.26
| Facility | | $34.67 | $575.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,513.56 / $3,311.31
| Professional | | $977.24 | $1,513.56 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,621.81
| Professional | | $1,380.38 | $1,380.38 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $2,454.71
| Facility | | $1,122.02 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,258.93 / $2,187.76
| Professional | | $977.24 | $1,258.93 | $2,187.76 |