- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $10,964.78 / $16,595.87
| Facility | | $1,513.56 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $1,513.56
| Professional | | $398.11 | $645.65 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $2,238.72
| Professional | | $1,258.93 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $3,548.13
| Facility | | $478.63 | $741.31 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $2,691.53
| Professional | | $1,258.93 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $2,951.21
| Professional | | $1,621.81 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $2,754.23
| Facility | | $478.63 | $741.31 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $707.95 / $1,659.59
| Professional | | $60.26 | $707.95 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $2,951.21
| Professional | | $575.44 | $1,995.26 | $2,951.21 |