- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,918.31 / $10,964.78
| Facility | | $4,168.69 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $2,238.72
| Professional | | $478.63 | $630.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $851.14 / $1,819.70
| Professional | | $478.63 | $851.14 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $575.44 / $794.33
| Professional | | $457.09 | $575.44 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $22,908.68 / $36,307.81
| Facility | | $14,454.40 | $22,908.68 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $691.83 / $2,290.87
| Professional | | $467.74 | $691.83 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,762.47 / $15,135.61
| Facility | | $3,630.78 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $1,479.11
| Professional | | $416.87 | $602.56 | $1,479.11 |