- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,570.88 / $12,302.69
| Facility | | $2,187.76 | $4,570.88 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $3,019.95
| Professional | | $1,737.80 | $2,137.96 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,466.84 / $12,882.50
| Facility | | $1,905.46 | $4,466.84 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $2,884.03
| Professional | | $208.93 | $208.93 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,265.80 / $10,715.19
| Facility | | $1,737.80 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,890.45 / $7,244.36
| Professional | | $3,090.30 | $3,890.45 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,630.27 / $3,162.28
| Facility | | $1,584.89 | $2,630.27 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $3,162.28
| Professional | | $1,122.02 | $1,584.89 | $3,162.28 |