- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,011.87 / $13,182.57
| Facility | | $2,398.83 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $3,388.44
| Professional | | $1,905.46 | $2,344.23 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,495.41 / $14,791.08
| Facility | | $2,454.71 | $5,495.41 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,230.27 / $3,890.45
| Professional | | $1,174.90 | $1,230.27 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,786.30 / $12,302.69
| Facility | | $1,905.46 | $4,786.30 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,265.80 / $7,943.28
| Professional | | $3,388.44 | $4,265.80 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $3,467.37
| Facility | | $1,737.80 | $2,951.21 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $3,467.37
| Professional | | $1,230.27 | $1,737.80 | $3,467.37 |