- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $11,220.18
| Facility | | $1,548.82 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $3,388.44
| Professional | | $1,412.54 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,709.64 / $16,982.44
| Facility | | $3,090.30 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,905.46 / $3,630.78
| Professional | | $1,288.25 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,570.88 / $12,589.25
| Facility | | $1,737.80 | $4,570.88 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $6,309.57
| Professional | | $2,884.03 | $4,265.80 | $6,309.57 |
- 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
- $1,258.93 / $1,819.70 / $3,467.37
| Professional | | $1,258.93 | $1,819.70 | $3,467.37 |