- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,128.61 / $12,022.64
| Facility | | $1,122.02 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,548.82
| Professional | | $602.56 | $691.83 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,165.95 / $13,803.84
| Facility | | $2,818.38 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,621.81
| Professional | | $549.54 | $812.83 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,737.80 / $4,786.30
| Facility | | $323.59 | $1,737.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $954.99 / $2,089.30
| Professional | | $630.96 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $17,782.79
| Facility | | $2,884.03 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,445.44
| Professional | | $549.54 | $776.25 | $1,445.44 |