- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $12,022.64 / $14,791.08
| Facility | | $1,071.52 | $12,022.64 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $2,754.23 / $4,677.35
| Professional | | $162.18 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $9,120.11
| Professional | | $602.56 | $602.56 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,715.35 / $16,595.87
| Facility | | $870.96 | $3,715.35 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,412.54 / $15,848.93
| Professional | | $371.54 | $1,412.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $16,982.44
| Professional | | $707.95 | $1,122.02 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,230.27 / $16,595.87
| Facility | | $316.23 | $1,230.27 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $239.88 / $9,120.11
| Professional | | $60.26 | $239.88 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,202.26 / $7,943.28
| Professional | | $446.68 | $1,202.26 | $7,943.28 |