- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,466.84 / $10,964.78
| Facility | | $1,174.90 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $954.99 / $2,089.30
| Professional | | $812.83 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,471.29 / $22,387.21
| Facility | | $3,467.37 | $10,471.29 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $2,187.76
| Professional | | $794.33 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,884.03 / $7,943.28
| Facility | | $1,096.48 | $2,884.03 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,630.27 / $4,168.69
| Professional | | $1,548.82 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,995.26
| Professional | | $758.58 | $1,071.52 | $1,995.26 |