- 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
- $1,230.27 / $1,479.11 / $3,019.95
| Professional | | $1,230.27 | $1,479.11 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,197.01 / $33,113.11
| Facility | | $11,481.54 | $18,197.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,778.28 / $2,398.83
| Professional | | $1,380.38 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $2,454.71
| Professional | | $1,412.54 | $1,819.70 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,513.56 / $4,786.30
| Professional | | $1,479.11 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,258.93
| Professional | | $1,047.13 | $1,047.13 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,128.31 / $16,595.87
| Facility | | $3,548.13 | $8,128.31 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,819.70 / $3,019.95
| Professional | | $1,445.44 | $1,819.70 | $3,019.95 |