- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,677.35 / $12,022.64
| Facility | | $1,698.24 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,905.46 / $3,890.45
| Professional | | $1,548.82 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,748.98 / $25,703.96
| Facility | | $4,168.69 | $11,748.98 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $4,265.80
| Professional | | $1,513.56 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,466.84 / $13,803.84
| Facility | | $398.11 | $4,466.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,630.27 / $5,370.32
| Professional | | $1,621.81 | $2,630.27 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,137.96 / $3,890.45
| Professional | | $1,479.11 | $2,137.96 | $3,890.45 |