- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,623.41 / $13,182.57
| Facility | | $1,258.93 | $5,623.41 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,230.27
| Professional | | $562.34 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $11,481.54 / $22,387.21
| Facility | | $3,467.37 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,445.44
| Professional | | $549.54 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,187.76 / $5,370.32
| Facility | | $512.86 | $2,187.76 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,288.25 / $2,884.03
| Professional | | $616.60 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,918.31 / $15,488.17
| Facility | | $2,238.72 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,445.44
| Professional | | $575.44 | $776.25 | $1,445.44 |