- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $11,481.54
| Facility | | $1,621.81 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,621.81 / $3,548.13
| Professional | | $1,318.26 | $1,621.81 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,332.54 / $17,782.79
| Facility | | $3,388.44 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $3,630.78
| Professional | | $1,258.93 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,365.16 / $12,302.69
| Facility | | $323.59 | $4,365.16 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,187.76 / $4,677.35
| Professional | | $1,348.96 | $2,187.76 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,803.84
| Facility | | $1,995.26 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,778.28 / $3,235.94
| Professional | | $1,230.27 | $1,778.28 | $3,235.94 |