- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,888.44 / $14,125.38
| Facility | | $1,230.27 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,949.84
| Professional | | $602.56 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,511.38 / $17,378.01
| Facility | | $3,630.78 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,737.80
| Professional | | $575.44 | $891.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,290.87 / $11,748.98
| Facility | | $933.25 | $2,290.87 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,023.29 / $2,238.72
| Professional | | $630.96 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,513.56
| Professional | | $575.44 | $812.83 | $1,513.56 |