- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.94 / $7,769.24 / $15,028.22
| Facility | | $5,906.94 | $7,769.24 | $15,028.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.49 / $290.72 / $494.24
| Professional | | $150.49 | $290.72 | $494.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.76 / $865.83 / $8,816.00
| Facility | | $494.76 | $865.83 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.66 / $533.45 / $1,556.32
| Professional | | $312.66 | $533.45 | $1,556.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.03 / $1,326.82 / $3,986.14
| Facility | | $733.03 | $1,326.82 | $3,986.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.19 / $806.11 / $1,067.68
| Professional | | $601.19 | $806.11 | $1,067.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.66 / $533.92 / $1,251.74
| Professional | | $312.66 | $533.92 | $1,251.74 |