- 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
- $489.78 / $724.44 / $1,698.24
| Professional | | $489.78 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,862.09 / $2,454.71
| Professional | | $1,380.38 | $1,862.09 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $870.96 / $3,890.45
| Facility | | $524.81 | $870.96 | $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 / $3,235.94
| Professional | | $1,819.70 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $3,019.95
| Facility | | $537.03 | $851.14 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $776.25 / $1,862.09
| Professional | | $60.26 | $776.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,238.72 / $3,235.94
| Professional | | $660.69 | $2,238.72 | $3,235.94 |