- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $10,964.78 / $16,595.87
| Facility | | $1,819.70 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,819.70
| Professional | | $588.84 | $776.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,995.26 / $2,630.27
| Professional | | $1,513.56 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,258.93 / $4,168.69
| Facility | | $562.34 | $1,258.93 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,137.96 / $3,162.28
| Professional | | $1,479.11 | $2,137.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,570.40 / $3,548.13
| Professional | | $1,949.84 | $2,570.40 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,174.90 / $3,311.31
| Facility | | $575.44 | $1,174.90 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $831.76 / $1,995.26
| Professional | | $60.26 | $831.76 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $2,398.83 / $3,548.13
| Professional | | $707.95 | $2,398.83 | $3,548.13 |