- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.73 / $3,706.14 / $5,496.04
| Facility | | $1,141.73 | $3,706.14 | $5,496.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.40 / $469.26 / $683.74
| Professional | | $350.40 | $469.26 | $683.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.15 / $673.12 / $1,022.23
| Professional | | $572.15 | $673.12 | $1,022.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.98 / $715.61 / $1,198.24
| Professional | | $523.98 | $715.61 | $1,198.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,685.00 / $13,185.00 / $24,205.00
| Facility | | $4,685.00 | $13,185.00 | $24,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.41 / $748.28 / $1,170.83
| Professional | | $582.41 | $748.28 | $1,170.83 |