- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,760.83 / $14,125.38
| Facility | | $1,949.84 | $6,760.83 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $2,238.72
| Professional | | $436.52 | $602.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $3,162.28
| Facility | | $478.63 | $758.58 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,348.96 / $3,311.31
| Professional | | $691.83 | $1,348.96 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,951.21
| Professional | | $1,862.09 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,238.72 / $3,162.28
| Facility | | $776.25 | $2,238.72 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $457.09 / $1,659.59
| Professional | | $60.26 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,318.26 / $3,311.31
| Professional | | $1,174.90 | $1,318.26 | $3,311.31 |