- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,079.46 / $16,982.44
| Facility | | $2,041.74 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,238.72
| Professional | | $1,348.96 | $1,905.46 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $15,135.61 / $34,673.69
| Facility | | $5,754.40 | $15,135.61 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $3,467.37
| Professional | | $1,148.15 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $16,595.87 / $38,018.94
| Facility | | $6,760.83 | $16,595.87 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,570.88 / $10,232.93
| Professional | | $3,311.31 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,570.40 / $4,786.30
| Professional | | $1,737.80 | $2,570.40 | $4,786.30 |