- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,549.93 / $16,595.87
| Facility | | $1,862.09 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $1,862.09
| Professional | | $602.56 | $794.33 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $2,754.23
| Professional | | $1,548.82 | $2,041.74 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,348.96 / $4,265.80
| Facility | | $575.44 | $1,348.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,187.76 / $3,311.31
| Professional | | $1,513.56 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,630.27 / $3,630.78
| Professional | | $1,995.26 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,230.27 / $3,388.44
| Facility | | $588.84 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $851.14 / $2,041.74
| Professional | | $60.26 | $851.14 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,570.40 / $3,630.78
| Professional | | $741.31 | $2,570.40 | $3,630.78 |