- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $10,964.78 / $16,595.87
| Facility | | $1,479.11 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,479.11
| Professional | | $457.09 | $630.96 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $2,187.76
| Professional | | $1,202.26 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $831.76 / $3,388.44
| Facility | | $457.09 | $831.76 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,737.80 / $2,630.27
| Professional | | $1,202.26 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,089.30 / $2,818.38
| Professional | | $1,584.89 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $2,630.27
| Facility | | $467.74 | $794.33 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $660.69 / $1,584.89
| Professional | | $60.26 | $660.69 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,187.76 / $2,818.38
| Professional | | $588.84 | $2,187.76 | $2,818.38 |