- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,677.35 / $12,022.64
| Facility | | $1,584.89 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $3,467.37
| Professional | | $1,380.38 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,748.98 / $25,118.86
| Facility | | $4,168.69 | $11,748.98 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $3,801.89
| Professional | | $1,348.96 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,073.80 / $13,803.84
| Facility | | $398.11 | $4,073.80 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,344.23 / $4,897.79
| Professional | | $1,479.11 | $2,344.23 | $4,897.79 |
- 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
- $1,348.96 / $1,905.46 / $3,548.13
| Professional | | $1,348.96 | $1,905.46 | $3,548.13 |