- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,754.40 / $14,454.40
| Facility | | $2,630.27 | $5,754.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,570.40 / $3,467.37
| Professional | | $1,778.28 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,888.44 / $17,378.01
| Facility | | $2,511.89 | $5,888.44 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $263.03 / $4,365.16
| Professional | | $239.88 | $263.03 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,623.41 / $14,791.08
| Facility | | $2,290.87 | $5,623.41 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,128.61 / $10,471.29
| Professional | | $4,073.80 | $5,128.61 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,467.37 / $4,168.69
| Facility | | $2,089.30 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $4,168.69
| Professional | | $1,479.11 | $2,089.30 | $4,168.69 |