- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,754.40 / $13,803.84
| Facility | | $1,819.70 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,089.30 / $4,365.16
| Professional | | $1,445.44 | $2,089.30 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,762.47 / $15,848.93
| Facility | | $3,311.31 | $7,762.47 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $3,801.89
| Professional | | $1,230.27 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,630.78 / $3,630.78
| Facility | | $398.11 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,265.80 / $10,232.93
| Professional | | $3,801.89 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,912.51 / $20,892.96
| Facility | | $2,884.03 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,238.72 / $4,677.35
| Professional | | $1,258.93 | $2,238.72 | $4,677.35 |