- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,754.40 / $14,125.38
| Facility | | $1,230.27 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $758.58 / $1,698.24
| Professional | | $588.84 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,715.19 / $20,417.38
| Facility | | $3,715.35 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $1,584.89
| Professional | | $512.86 | $794.33 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $6,025.60
| Facility | | $1,096.48 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $2,187.76
| Professional | | $575.44 | $977.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,479.11
| Professional | | $524.81 | $758.58 | $1,479.11 |