- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,570.88 / $11,220.18
| Facility | | $1,737.80 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,041.74 / $4,265.80
| Professional | | $1,621.81 | $2,041.74 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,589.25 / $28,840.32
| Facility | | $4,466.84 | $12,589.25 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,630.27 / $4,677.35
| Professional | | $1,819.70 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $5,011.87 / $14,454.40
| Facility | | $323.59 | $5,011.87 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,754.23 / $5,754.40
| Professional | | $1,737.80 | $2,754.23 | $5,754.40 |
- 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
- $1,584.89 / $2,238.72 / $4,168.69
| Professional | | $1,584.89 | $2,238.72 | $4,168.69 |