- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,570.88 / $11,220.18
| Facility | | $1,445.44 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $3,467.37
| Professional | | $1,318.26 | $1,548.82 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,715.19 / $20,417.38
| Facility | | $3,981.07 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $3,715.35
| Professional | | $1,348.96 | $2,041.74 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,570.88 / $12,882.50
| Facility | | $323.59 | $4,570.88 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $4,897.79
| Professional | | $1,412.54 | $2,238.72 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,232.93 / $23,988.33
| Facility | | $3,715.35 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $3,388.44
| Professional | | $1,318.26 | $1,862.09 | $3,388.44 |