- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.63 / $10,175.36 / $13,413.92
| Facility | | $1,425.63 | $10,175.36 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.37 / $1,849.42 / $2,405.35
| Professional | | $1,704.37 | $1,849.42 | $2,405.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.22 / $832.27 / $1,617.67
| Professional | | $609.22 | $832.27 | $1,617.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.37 / $2,405.35 / $3,367.49
| Facility | | $1,704.37 | $2,405.35 | $3,367.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.73 / $1,020.87 / $1,482.75
| Professional | | $850.73 | $1,020.87 | $1,482.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.62 / $1,470.70 / $2,136.14
| Professional | | $839.62 | $1,470.70 | $2,136.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.37 / $2,405.35 / $3,367.49
| Facility | | $1,704.37 | $2,405.35 | $3,367.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.22 / $1,303.75 / $2,432.36
| Professional | | $609.22 | $1,303.75 | $2,432.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.51 / $1,294.14 / $1,952.35
| Professional | | $552.51 | $1,294.14 | $1,952.35 |