- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,786.30 / $11,481.54
| Facility | | $1,548.82 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $3,162.28
| Professional | | $1,318.26 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,488.17 / $31,622.78
| Facility | | $4,897.79 | $15,488.17 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $4,073.80
| Professional | | $1,380.38 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,265.80 / $16,595.87
| Facility | | $398.11 | $4,265.80 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $4,466.84
| Professional | | $1,445.44 | $2,454.71 | $4,466.84 |
- 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
- $1,318.26 / $2,089.30 / $3,548.13
| Professional | | $1,318.26 | $2,089.30 | $3,548.13 |