- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,897.79 / $11,748.98
| Facility | | $1,698.24 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,659.59 / $4,073.80
| Professional | | $1,479.11 | $1,659.59 | $4,073.80 |
- 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
- $1,412.54 / $1,995.26 / $3,981.07
| Professional | | $1,412.54 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,265.80 / $11,748.98
| Facility | | $323.59 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $5,128.61
| Professional | | $1,513.56 | $2,398.83 | $5,128.61 |
- 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
- $1,348.96 / $1,905.46 / $3,548.13
| Professional | | $1,348.96 | $1,905.46 | $3,548.13 |