- 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 / $1,513.56 / $2,951.21
| Professional | | $1,230.27 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,715.19 / $20,892.96
| Facility | | $4,168.69 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,819.70 / $3,311.31
| Professional | | $1,230.27 | $1,819.70 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,981.07 / $11,481.54
| Facility | | $323.59 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,041.74 / $4,365.16
| Professional | | $1,288.25 | $2,041.74 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $12,882.50
| Facility | | $851.14 | $3,235.94 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,019.95
| Professional | | $1,148.15 | $1,659.59 | $3,019.95 |