- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,677.35 / $11,481.54
| Facility | | $1,584.89 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $3,630.78
| Professional | | $1,412.54 | $1,659.59 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $24,547.09
| Facility | | $4,677.35 | $12,302.69 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $3,981.07
| Professional | | $1,380.38 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,388.44 / $12,882.50
| Facility | | $602.56 | $3,388.44 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $5,011.87
| Professional | | $1,513.56 | $2,344.23 | $5,011.87 |
- 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
- $1,318.26 / $1,862.09 / $3,467.37
| Professional | | $1,318.26 | $1,862.09 | $3,467.37 |