- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,606.93 / $16,595.87
| Facility | | $1,096.48 | $6,606.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $1,995.26
| Professional | | $331.13 | $426.58 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $2,818.38
| Facility | | $398.11 | $562.34 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $2,511.89
| Professional | | $831.76 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,089.30
| Professional | | $1,479.11 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,995.26 / $2,818.38
| Facility | | $562.34 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $346.74 / $1,202.26
| Professional | | $60.26 | $346.74 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $977.24 / $2,454.71
| Professional | | $537.03 | $977.24 | $2,454.71 |