- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,606.93 / $16,595.87
| Facility | | $1,445.44 | $6,606.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $2,187.76
| Professional | | $436.52 | $602.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $758.58 / $3,090.30
| Facility | | $467.74 | $758.58 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,318.26 / $3,235.94
| Professional | | $1,023.29 | $1,318.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,884.03
| Professional | | $1,862.09 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,187.76 / $3,162.28
| Facility | | $776.25 | $2,187.76 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $446.68 / $1,621.81
| Professional | | $60.26 | $446.68 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,288.25 / $3,019.95
| Professional | | $1,174.90 | $1,288.25 | $3,019.95 |