- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $10,964.78 / $16,595.87
| Facility | | $1,513.56 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,513.56
| Professional | | $478.63 | $602.56 | $1,513.56 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $1,949.84
| Facility | | $501.19 | $741.31 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,884.03
| Professional | | $1,023.29 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,089.30 / $2,951.21
| Professional | | $1,288.25 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,949.84
| Facility | | $501.19 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $758.58 / $1,698.24
| Professional | | $60.26 | $758.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,348.96 / $3,235.94
| Professional | | $478.63 | $1,348.96 | $3,235.94 |