- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $11,481.54
| Facility | | $1,819.70 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $5,011.87
| Professional | | $1,862.09 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,471.29 / $20,892.96
| Facility | | $3,890.45 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,570.40 / $5,011.87
| Professional | | $1,737.80 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,248.07 / $14,791.08
| Facility | | $398.11 | $5,248.07 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,019.95 / $6,760.83
| Professional | | $1,862.09 | $3,019.95 | $6,760.83 |
- 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
- $1,698.24 / $2,454.71 / $4,677.35
| Professional | | $1,698.24 | $2,454.71 | $4,677.35 |