- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $11,748.98
| Facility | | $1,819.70 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $2,951.21
| Professional | | $1,548.82 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,585.78 / $15,488.17
| Facility | | $3,311.31 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $2,238.72 / $4,168.69
| Professional | | $218.78 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,290.87 / $4,677.35
| Facility | | $1,412.54 | $2,290.87 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $977.24
| Professional | | $588.84 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,471.29
| Facility | | $1,584.89 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,162.28 / $5,623.41
| Professional | | $2,089.30 | $3,162.28 | $5,623.41 |