- 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 / $1,479.11 / $2,754.23
| Professional | | $1,230.27 | $1,479.11 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $16,982.44
| Facility | | $3,388.44 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,884.03
| Professional | | $1,174.90 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,344.23 / $5,623.41
| Facility | | $398.11 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,819.70 / $3,801.89
| Professional | | $1,122.02 | $1,819.70 | $3,801.89 |
- 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 |