- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,022.64 / $16,595.87
| Facility | | $1,230.27 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $1,949.84
| Professional | | $363.08 | $467.74 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $2,691.53
| Facility | | $436.52 | $549.54 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,754.23
| Professional | | $954.99 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,584.89 / $2,344.23
| Professional | | $1,318.26 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,949.84 / $2,754.23
| Facility | | $537.03 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $389.05 / $1,348.96
| Professional | | $60.26 | $389.05 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,071.52 / $2,691.53
| Professional | | $1,047.13 | $1,071.52 | $2,691.53 |