- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,754.40 / $13,489.63
| Facility | | $1,230.27 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,318.26
| Professional | | $588.84 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,715.19 / $23,988.33
| Facility | | $3,467.37 | $10,715.19 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,412.54
| Professional | | $562.34 | $776.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,041.74 / $13,489.63
| Facility | | $512.86 | $2,041.74 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,819.70
| Professional | | $602.56 | $912.01 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $8,317.64 / $19,054.61
| Facility | | $2,089.30 | $8,317.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $794.33 / $1,380.38
| Professional | | $549.54 | $794.33 | $1,380.38 |