- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,128.61 / $12,022.64
| Facility | | $1,778.28 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $4,073.80
| Professional | | $1,513.56 | $1,905.46 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,332.54 / $17,782.79
| Facility | | $2,951.21 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $4,570.88
| Professional | | $1,513.56 | $2,238.72 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,677.35 / $12,302.69
| Facility | | $1,659.59 | $4,677.35 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,511.89 / $5,495.41
| Professional | | $1,584.89 | $2,511.89 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $3,890.45
| Professional | | $1,445.44 | $2,137.96 | $3,890.45 |