- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $10,964.78 / $16,595.87
| Facility | | $1,698.24 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,698.24
| Professional | | $524.81 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $2,511.89
| Professional | | $1,412.54 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $3,890.45
| Facility | | $537.03 | $794.33 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $3,019.95
| Professional | | $1,380.38 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $3,311.31
| Professional | | $1,819.70 | $2,398.83 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $3,090.30
| Facility | | $537.03 | $776.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $794.33 / $1,862.09
| Professional | | $60.26 | $794.33 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,570.40 / $3,311.31
| Professional | | $676.08 | $2,570.40 | $3,311.31 |