- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,677.35 / $11,748.98
| Facility | | $1,445.44 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $3,235.94
| Professional | | $1,258.93 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $26,915.35
| Facility | | $4,677.35 | $12,302.69 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,041.74 / $3,548.13
| Professional | | $1,318.26 | $2,041.74 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,890.45 / $11,481.54
| Facility | | $398.11 | $3,890.45 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $4,365.16
| Professional | | $1,348.96 | $2,041.74 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,090.30
| Professional | | $1,148.15 | $1,659.59 | $3,090.30 |