- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,570.88 / $11,220.18
| Facility | | $1,659.59 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $3,548.13
| Professional | | $1,621.81 | $1,905.46 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,332.54 / $16,982.44
| Facility | | $3,388.44 | $9,332.54 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $3,801.89
| Professional | | $1,548.82 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,019.95 / $7,762.47
| Facility | | $398.11 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,398.83 / $5,011.87
| Professional | | $1,445.44 | $2,398.83 | $5,011.87 |
- 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
- $1,479.11 / $2,041.74 / $3,715.35
| Professional | | $1,479.11 | $2,041.74 | $3,715.35 |