- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,897.79 / $11,748.98
| Facility | | $1,513.56 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $3,235.94
| Professional | | $1,174.90 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $17,782.79
| Facility | | $3,548.13 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,778.28 / $3,548.13
| Professional | | $1,148.15 | $1,778.28 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,467.37 / $9,549.93
| Facility | | $323.59 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,041.74 / $3,981.07
| Professional | | $1,288.25 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $3,019.95
| Professional | | $1,174.90 | $1,698.24 | $3,019.95 |