- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,597.78 / $9,933.95 / $13,413.92
| Facility | | $1,597.78 | $9,933.95 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.55 / $742.89 / $2,695.82
| Professional | | $371.55 | $742.89 | $2,695.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,508.79 / $1,508.79 / $1,783.16
| Professional | | $1,508.79 | $1,508.79 | $1,783.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.32 / $2,695.82 / $3,774.15
| Facility | | $557.32 | $2,695.82 | $3,774.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.03 / $2,963.10 / $3,729.83
| Professional | | $1,141.03 | $2,963.10 | $3,729.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,890.00 / $2,349.00 / $3,126.00
| Professional | | $1,890.00 | $2,349.00 | $3,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.32 / $2,695.82 / $3,774.15
| Facility | | $557.32 | $2,695.82 | $3,774.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.28 / $2,166.25 / $3,141.60
| Professional | | $827.28 | $2,166.25 | $3,141.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.70 / $2,152.06 / $3,566.30
| Professional | | $1,398.70 | $2,152.06 | $3,566.30 |