- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.78 / $7,340.00 / $13,413.92
| Facility | | $1,466.78 | $7,340.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.25 / $538.49 / $2,487.71
| Professional | | $322.25 | $538.49 | $2,487.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.45 / $1,278.32 / $2,276.27
| Professional | | $888.45 | $1,278.32 | $2,276.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.70 / $1,773.03 / $3,482.81
| Facility | | $438.70 | $1,773.03 | $3,482.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.65 / $1,549.71 / $3,114.15
| Professional | | $901.65 | $1,549.71 | $3,114.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.75 / $2,040.45 / $3,022.00
| Professional | | $1,393.75 | $2,040.45 | $3,022.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.48 / $1,950.33 / $3,482.81
| Facility | | $460.48 | $1,950.33 | $3,482.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.66 / $1,962.70 / $2,954.19
| Professional | | $758.66 | $1,962.70 | $2,954.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.48 / $2,349.34 / $2,953.46
| Professional | | $1,342.48 | $2,349.34 | $2,953.46 |