- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $12,022.64 / $16,595.87
| Facility | | $1,659.59 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,659.59
| Professional | | $512.86 | $676.08 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,862.09
| Professional | | $549.54 | $776.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $2,137.96
| Facility | | $562.34 | $794.33 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,778.28 / $3,467.37
| Professional | | $1,258.93 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $3,311.31
| Professional | | $1,318.26 | $2,290.87 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $2,137.96
| Facility | | $616.60 | $891.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $831.76 / $1,862.09
| Professional | | $60.26 | $831.76 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,479.11 / $3,548.13
| Professional | | $524.81 | $1,479.11 | $3,548.13 |