- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $10,715.19
| Facility | | $1,862.09 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,258.93 / $3,162.28
| Professional | | $1,122.02 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $20,417.38 / $31,622.78
| Facility | | $4,786.30 | $20,417.38 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,737.80 / $2,754.23
| Professional | | $1,348.96 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $12,022.64 / $38,018.94
| Facility | | $2,089.30 | $12,022.64 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $2,818.38
| Professional | | $1,258.93 | $1,621.81 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $6,760.83
| Professional | | $1,148.15 | $1,621.81 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $2,398.83
| Professional | | $1,148.15 | $1,148.15 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $14,454.40 / $24,547.09
| Facility | | $10,471.29 | $14,454.40 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,659.59 / $3,019.95
| Professional | | $1,230.27 | $1,659.59 | $3,019.95 |