- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $9,549.93 / $16,595.87
| Facility | | $1,584.89 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,584.89
| Professional | | $467.74 | $660.69 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,737.80 / $2,290.87
| Professional | | $1,288.25 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $3,630.78
| Facility | | $426.58 | $676.08 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $2,754.23
| Professional | | $1,000.00 | $1,584.89 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,187.76 / $3,019.95
| Professional | | $1,659.59 | $2,187.76 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $2,884.03
| Facility | | $478.63 | $630.96 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $724.44 / $1,737.80
| Professional | | $60.26 | $724.44 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,398.83 / $3,090.30
| Professional | | $512.86 | $2,398.83 | $3,090.30 |