- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,365.16 / $10,964.78
| Facility | | $1,023.29 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,584.89
| Professional | | $588.84 | $707.95 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,589.25
| Facility | | $2,454.71 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,621.81
| Professional | | $588.84 | $870.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,137.96 / $5,754.40
| Facility | | $933.25 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,023.29 / $2,187.76
| Professional | | $630.96 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,513.56
| Professional | | $562.34 | $831.76 | $1,513.56 |