- 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
- $524.81 / $758.58 / $1,819.70
| Professional | | $524.81 | $758.58 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,995.26 / $2,630.27
| Professional | | $1,479.11 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $4,168.69
| Facility | | $562.34 | $891.25 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $3,162.28
| Professional | | $1,445.44 | $2,137.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,570.40 / $3,467.37
| Professional | | $1,949.84 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $3,235.94
| Facility | | $575.44 | $891.25 | $3,235.94 |
- 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 / $2,691.53 / $3,467.37
| Professional | | $707.95 | $2,691.53 | $3,467.37 |