- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,677.35 / $12,589.25
| Facility | | $1,445.44 | $4,677.35 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $3,235.94
| Professional | | $1,258.93 | $1,584.89 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,182.57 / $28,840.32
| Facility | | $4,570.88 | $13,182.57 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $3,548.13
| Professional | | $1,202.26 | $1,905.46 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,890.45 / $10,715.19
| Facility | | $323.59 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $4,466.84
| Professional | | $1,348.96 | $2,137.96 | $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
- $1,230.27 / $1,737.80 / $3,235.94
| Professional | | $1,230.27 | $1,737.80 | $3,235.94 |