- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $11,220.18
| Facility | | $1,778.28 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,137.96 / $4,265.80
| Professional | | $1,778.28 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,481.54 / $21,877.62
| Facility | | $4,073.80 | $11,481.54 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $4,677.35
| Professional | | $1,698.24 | $2,511.89 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,786.30 / $13,489.63
| Facility | | $398.11 | $4,786.30 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,884.03 / $6,165.95
| Professional | | $1,819.70 | $2,884.03 | $6,165.95 |
- 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
- $1,659.59 / $2,398.83 / $4,365.16
| Professional | | $1,659.59 | $2,398.83 | $4,365.16 |