- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,570.88 / $11,481.54
| Facility | | $1,445.44 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $2,754.23
| Professional | | $1,230.27 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $17,378.01
| Facility | | $3,548.13 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $2,884.03
| Professional | | $1,122.02 | $1,479.11 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,290.87 / $5,754.40
| Facility | | $457.09 | $2,290.87 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $3,715.35
| Professional | | $1,122.02 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,548.82 / $2,818.38
| Professional | | $1,122.02 | $1,548.82 | $2,818.38 |