- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,290.87 / $11,481.54
| Facility | | $1,445.44 | $2,290.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $3,981.07
| Professional | | $1,174.90 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,041.74 / $3,890.45
| Professional | | $1,258.93 | $2,041.74 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $3,467.37
| Professional | | $1,412.54 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $2,691.53
| Facility | | $1,174.90 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $2,290.87 / $3,890.45
| Professional | | $5.01 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,302.69 / $19,054.61
| Facility | | $4,466.84 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $3,019.95
| Professional | | $1,202.26 | $1,621.81 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $42,657.95
| Facility | | $16,595.87 | $16,595.87 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $12,589.25
| Professional | | $10,715.19 | $10,715.19 | $12,589.25 |