- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,888.44 / $14,125.38
| Facility | | $1,412.54 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,445.44
| Professional | | $446.68 | $602.56 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,290.87
| Professional | | $1,174.90 | $1,548.82 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $977.24 / $3,311.31
| Facility | | $446.68 | $977.24 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $2,691.53
| Professional | | $1,174.90 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,187.76 / $2,951.21
| Professional | | $1,659.59 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $2,818.38
| Facility | | $489.78 | $794.33 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $707.95 / $1,548.82
| Professional | | $60.26 | $707.95 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $2,137.96 / $2,754.23
| Professional | | $602.56 | $2,137.96 | $2,754.23 |