- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,897.79 / $11,481.54
| Facility | | $1,548.82 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $3,019.95
| Professional | | $1,202.26 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,772.37 / $17,782.79
| Facility | | $3,467.37 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $3,311.31
| Professional | | $1,230.27 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,715.35 / $9,772.37
| Facility | | $323.59 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $4,168.69
| Professional | | $1,288.25 | $1,995.26 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $16,218.10
| Facility | | $2,398.83 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $2,951.21
| Professional | | $1,122.02 | $1,584.89 | $2,951.21 |