- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,897.79 / $11,481.54
| Facility | | $1,479.11 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,380.38 / $3,019.95
| Professional | | $1,071.52 | $1,380.38 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,912.51 / $17,782.79
| Facility | | $3,235.94 | $8,912.51 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,818.38
| Professional | | $1,047.13 | $1,513.56 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,890.45 / $8,912.51
| Facility | | $1,995.26 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,778.28 / $3,890.45
| Professional | | $1,071.52 | $1,778.28 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $2,691.53
| Professional | | $977.24 | $1,412.54 | $2,691.53 |