- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,888.44 / $14,125.38
| Facility | | $1,548.82 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $2,884.03
| Professional | | $1,071.52 | $1,318.26 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $23,442.29
| Facility | | $4,677.35 | $12,589.25 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $3,090.30
| Professional | | $1,071.52 | $1,659.59 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,715.35 / $10,471.29
| Facility | | $323.59 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $3,981.07
| Professional | | $1,174.90 | $1,905.46 | $3,981.07 |
- 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
- $1,096.48 / $1,584.89 / $2,818.38
| Professional | | $1,096.48 | $1,584.89 | $2,818.38 |