- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $10,232.93 / $16,218.10
| Facility | | $1,862.09 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $3,311.31
| Professional | | $1,513.56 | $1,819.70 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,398.83
| Professional | | $1,174.90 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,737.80 / $1,995.26
| Facility | | $1,584.89 | $1,737.80 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $3,235.94
| Professional | | $1,230.27 | $1,905.46 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $17,378.01
| Facility | | $5,011.87 | $11,481.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $3,162.28
| Professional | | $1,122.02 | $1,778.28 | $3,162.28 |