- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.07 / $10,175.36 / $13,413.92
| Facility | | $1,190.07 | $10,175.36 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.00 / $447.23 / $2,007.90
| Professional | | $274.00 | $447.23 | $2,007.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.17 / $726.56 / $1,352.11
| Professional | | $494.17 | $726.56 | $1,352.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.31 / $1,956.68 / $2,811.06
| Facility | | $1,368.31 | $1,956.68 | $2,811.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.23 / $810.27 / $1,224.63
| Professional | | $675.23 | $810.27 | $1,224.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.54 / $1,210.75 / $1,819.50
| Professional | | $666.54 | $1,210.75 | $1,819.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.31 / $1,956.68 / $2,811.06
| Facility | | $1,368.31 | $1,956.68 | $2,811.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.06 / $1,076.40 / $1,970.64
| Professional | | $504.06 | $1,076.40 | $1,970.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.94 / $1,081.68 / $1,631.83
| Professional | | $460.94 | $1,081.68 | $1,631.83 |