- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $9,772.37 / $16,595.87
| Facility | | $1,258.93 | $9,772.37 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $660.69 / $2,344.23
| Professional | | $457.09 | $660.69 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,621.81
| Professional | | $758.58 | $758.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $4,168.69
| Facility | | $2,344.23 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,290.87
| Professional | | $933.25 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $2,691.53
| Professional | | $1,621.81 | $2,187.76 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $3,388.44
| Facility | | $489.78 | $707.95 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $467.74 / $1,380.38
| Professional | | $60.26 | $467.74 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,122.02 / $3,981.07
| Professional | | $549.54 | $1,122.02 | $3,981.07 |