- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $9,549.93 / $16,595.87
| Facility | | $1,096.48 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $416.87 / $1,949.84
| Professional | | $323.59 | $416.87 | $1,949.84 |
- 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 / $2,754.23
| Facility | | $398.11 | $562.34 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $2,454.71
| Professional | | $831.76 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $2,041.74
| Professional | | $1,445.44 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $2,818.38
| Facility | | $562.34 | $1,949.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $338.84 / $1,202.26
| Professional | | $60.26 | $338.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $954.99 / $2,398.83
| Professional | | $912.01 | $954.99 | $2,398.83 |