- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,570.88 / $11,220.18
| Facility | | $1,479.11 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $2,884.03
| Professional | | $1,318.26 | $1,548.82 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $12,022.64 / $22,908.68
| Facility | | $3,801.89 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,819.70 / $3,235.94
| Professional | | $1,318.26 | $1,819.70 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,454.71 / $6,760.83
| Facility | | $371.54 | $2,454.71 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $3,981.07
| Professional | | $1,258.93 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $3,162.28
| Professional | | $1,258.93 | $1,819.70 | $3,162.28 |