- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.21 / $10,175.36 / $13,413.92
| Facility | | $1,603.21 | $10,175.36 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.83 / $2,572.21 / $3,079.28
| Professional | | $454.83 | $2,572.21 | $3,079.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.12 / $602.12 / $1,812.12
| Professional | | $602.12 | $602.12 | $1,812.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.51 / $693.97 / $4,403.37
| Facility | | $571.51 | $693.97 | $4,403.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.18 / $1,553.64 / $2,973.25
| Professional | | $1,136.18 | $1,553.64 | $2,973.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.25 / $2,204.40 / $2,980.35
| Professional | | $1,676.25 | $2,204.40 | $2,980.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.97 / $850.59 / $4,403.37
| Facility | | $693.97 | $850.59 | $4,403.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.12 / $2,204.40 / $3,082.47
| Professional | | $602.12 | $2,204.40 | $3,082.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.47 / $1,449.70 / $4,389.92
| Professional | | $658.47 | $1,449.70 | $4,389.92 |