- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,248.07 / $12,302.69
| Facility | | $1,621.81 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $3,548.13
| Professional | | $1,412.54 | $1,621.81 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,332.54 / $17,782.79
| Facility | | $3,388.44 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $3,801.89
| Professional | | $1,348.96 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,090.30 / $11,220.18
| Facility | | $398.11 | $3,090.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $4,897.79
| Professional | | $1,479.11 | $2,290.87 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,819.70 / $3,467.37
| Professional | | $1,288.25 | $1,819.70 | $3,467.37 |