- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $7,943.28 / $16,595.87
| Facility | | $1,479.11 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,230.27 / $2,187.76
| Professional | | $1,023.29 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,120.11 / $16,595.87
| Facility | | $3,715.35 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,380.38
| Professional | | $676.08 | $977.24 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,513.56 / $2,398.83
| Professional | | $794.33 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,479.11 / $2,511.89
| Facility | | $831.76 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,890.45 / $7,762.47
| Facility | | $1,122.02 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $2,570.40
| Professional | | $1,023.29 | $1,380.38 | $2,570.40 |