- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $11,481.54
| Facility | | $1,819.70 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,630.27
| Professional | | $1,862.09 | $1,862.09 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $9,549.93 / $17,782.79
| Facility | | $3,162.28 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $3,890.45
| Professional | | $1,445.44 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $1,230.27
| Facility | | $34.67 | $562.34 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $2,818.38
| Professional | | $346.74 | $562.34 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,019.95 / $10,232.93
| Facility | | $524.81 | $3,019.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,949.84 / $8,128.31
| Professional | | $1,258.93 | $1,949.84 | $8,128.31 |