- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,079.46 / $16,595.87
| Facility | | $1,905.46 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $2,290.87
| Professional | | $1,230.27 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,791.08 / $34,673.69
| Facility | | $5,623.41 | $14,791.08 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $162.18 / $2,398.83
| Professional | | $27.54 | $162.18 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $10,715.19 / $19,498.45
| Facility | | $3,388.44 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $7,244.36
| Professional | | $2,398.83 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $4,365.16
| Professional | | $1,659.59 | $2,511.89 | $4,365.16 |