- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $14,791.08
| Facility | | $3,235.94 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $7,079.46
| Professional | | $3,235.94 | $3,235.94 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,332.54 / $12,882.50
| Facility | | $7,244.36 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,951.21 / $3,548.13
| Professional | | $2,290.87 | $2,951.21 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $10,964.78
| Facility | | $1,071.52 | $1,479.11 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $10,964.78
| Professional | | $1,071.52 | $1,479.11 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,202.26 / $2,454.71
| Facility | | $229.09 | $1,202.26 | $2,454.71 |