- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,698.24 / $2,511.89
| Facility | | $1,479.11 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,288.25 / $1,949.84
| Professional | | $1,122.02 | $1,288.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $18,197.01
| Facility | | $13,182.57 | $13,182.57 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,778.28
| Professional | | $1,318.26 | $1,318.26 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $2,137.96
| Professional | | $1,047.13 | $1,778.28 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $16,595.87
| Facility | | $2,089.30 | $5,495.41 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $2,290.87
| Professional | | $1,122.02 | $1,445.44 | $2,290.87 |