- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,309.57 / $18,620.87
| Facility | | $1,023.29 | $6,309.57 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,630.27 / $15,848.93
| Professional | | $588.84 | $2,630.27 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $26,302.68
| Facility | | $4,466.84 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $8,128.31 / $19,498.45
| Professional | | $575.44 | $8,128.31 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $19,498.45 / $64,565.42
| Facility | | $707.95 | $19,498.45 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,691.53 / $23,442.29
| Professional | | $660.69 | $2,691.53 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $26,915.35
| Facility | | $3,630.78 | $10,964.78 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $7,413.10 / $18,197.01
| Professional | | $588.84 | $7,413.10 | $18,197.01 |