- 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
- $1,445.44 / $1,737.80 / $3,890.45
| Professional | | $1,445.44 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $25,118.86
| Facility | | $4,677.35 | $12,302.69 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $4,073.80
| Professional | | $1,412.54 | $2,041.74 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,019.95 / $11,220.18
| Facility | | $398.11 | $3,019.95 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,398.83 / $5,128.61
| Professional | | $1,548.82 | $2,398.83 | $5,128.61 |
- 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
- $1,348.96 / $1,905.46 / $3,630.78
| Professional | | $1,348.96 | $1,905.46 | $3,630.78 |