- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $10,964.78 / $16,595.87
| Facility | | $1,905.46 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,905.46
| Professional | | $478.63 | $794.33 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $2,818.38
| Professional | | $1,548.82 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $4,365.16
| Facility | | $588.84 | $954.99 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $3,388.44
| Professional | | $1,548.82 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,691.53 / $3,630.78
| Professional | | $1,995.26 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $933.25 / $3,388.44
| Facility | | $588.84 | $933.25 | $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 / $2,454.71 / $3,548.13
| Professional | | $741.31 | $2,454.71 | $3,548.13 |