- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $10,964.78 / $16,595.87
| Facility | | $1,949.84 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,949.84
| Professional | | $575.44 | $831.76 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $2,818.38
| Professional | | $1,584.89 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $4,466.84
| Facility | | $602.56 | $912.01 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,290.87 / $3,630.78
| Professional | | $1,548.82 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $3,801.89
| Professional | | $2,089.30 | $2,754.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $3,467.37
| Facility | | $616.60 | $912.01 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $891.25 / $2,137.96
| Professional | | $60.26 | $891.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,570.40 / $3,715.35
| Professional | | $758.58 | $2,570.40 | $3,715.35 |