- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,011.87 / $12,022.64
| Facility | | $1,621.81 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,621.81 / $4,365.16
| Professional | | $1,380.38 | $1,621.81 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $19,952.62
| Facility | | $3,630.78 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $4,073.80
| Professional | | $1,380.38 | $1,995.26 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,265.80 / $11,220.18
| Facility | | $323.59 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,238.72 / $4,897.79
| Professional | | $1,445.44 | $2,238.72 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,244.36 / $16,595.87
| Facility | | $2,344.23 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $3,388.44
| Professional | | $1,288.25 | $1,778.28 | $3,388.44 |